Stroke Diagnosis

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Your doctor will diagnose a stroke based on your symptoms, your medical history, a physical exam, and test results. Your healthcare provider will want to find out the type of stroke you have had, its cause, the part of the brain that is affected, and whether you have bleeding in the brain. If your doctor thinks you have had a transient ischemic attack (TIA), they will look for the cause to try to prevent a future stroke.

Your healthcare provider will order tests to help rule out other health problems with similar signs or symptoms.

Imaging tests look at the blood vessels in your brain. These images will help determine what type of stroke you had and exactly where it happened in your brain. The faster these tests can be done, the better your doctor can diagnose and treat you. There are several imaging tests used to diagnose stroke.

• Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a suspected stroke. A brain CT scan can show whether there is bleeding in the brain or damage to the brain cells from a stroke.
• Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of — or in addition to — a CT scan to diagnose a stroke. This test can identify changes in brain tissue and damage to brain cells.
• Other imaging tests may include digital subtraction angiography (DSA) and positron emission tomography (PET) to look for narrowed blood vessels in the neck, an aneurysm , or an arteriovenous malformation (AVM, or tangled blood vessels) in the brain.

Your doctor may also order other tests.

• Blood tests will test the red blood cell and platelet count and glucose (sugar) levels in your blood to make sure they are stable. These tests can also help determine whether a specific medicine can treat your stroke. Your doctor may also do blood tests to see how well your blood is clotting and to look for muscle damage.
• Electrocardiogram (EKG) can help find heart problems that may have led to a stroke. For example, this test can help diagnose atrial fibrillation or a previous heart attack.
• Lumbar puncture (also called a spinal tap) may be used if the imaging scan does not find any bleeding in the brain but your provider still thinks you may have had a hemorrhagic stroke. In this test, a needle is used to collect fluid from around your spine. The fluid is tested for substances that come from damaged blood cells.

Your doctor will ask you or a family member about your risk factors for stroke. Tell your provider if you or someone in your family has had a stroke. Your provider will also ask about your signs and symptoms and when they began. During a physical exam, your provider will check you for the following:

• Confusion
• Coordination and balance
• Mental alertness
• Numbness or weakness in your face, arms, and legs
• Trouble speaking or seeing clearly

The exam helps your provider determine how severe your stroke was and plan treatment.

Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. They will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit may suggest changed or lowered blood flow from plaque buildup in the carotid arteries.