• Diagnosis of Stroke

    A stroke is a medical emergency. If you think you are having a stroke, call for emergency medical services right away .
    A stroke can be diagnosed based on your signs and symptoms, as well as a physical and neurological examination performed when you arrive at the hospital. Once you are stabilized, your doctor may want other tests to determine the type of stroke, what area of the brain is affected, or to determine an underlying cause.

    Tests to Evaluate Stroke and Effect of Stroke

    Imaging Tests
    Imaging tests evaluate the brain, blood vessels, and surrounding structures. Detailed images can provide your doctor with information about areas of bleeding, blockage, or where the damaged area is located. Imaging tests include:
    Blood Tests
    Blood tests can also be used to evaluate platelet, glucose, electrolyte, and cholesterol levels, as well as blood clotting time. Assessment of blood components can help with diagnosing or ruling out a stroke. Specific blood tests can also test liver and kidney function.
    Electrical Activity Tests
    Electrical activity can be measured with:
    • Electroencephalogram (EEG)—to measure electrical activity of the brain via electrodes placed on your head
    • Evoked response test—to measure how your brain processes sensory information
    Other Tests
    Depending on the severity of your stroke, your doctor will evaluate swallowing, how you respond to food textures and tastes, as well as your language skills. Stroke often affects these parts of the brain. It will help determine the rehabilitation process needed during your recovery.
    A lumbar puncture may be done to check the cerebrospinal fluid (CSF). CSF surrounds and protects the brain and spinal cord. It can be examined if your doctor suspects the presence of an infection or a subarachnoid hemorrhage .

    Tests to Evaluate the Heart

    Many strokes are the result of cardiovascular disease. If your doctor suspects you have cardiovascular disease, you may have additional tests, such as:
    • Electrocardiogram (EKG)—To test the heart's electrical activity by measuring electrical currents through the heart muscle. A healthy heart creates a specific pattern on an EKG. A previous heart attack and heart damage will cause disruptions to this pattern. It can also be used to diagnose atrial fibrillation .
    • Electrocardiogram —Ultrasound detects abnormalities in the heart muscle by highlighting areas of poor blood flow.
    • Holter monitor—A small machine is belted around your waist and will record your heart rhythm over a period of 24 hours or more. It may be able to detect any rhythm abnormalities after a stroke.


    Albers GW, Amarenco P, Easton JD, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(suppl 6):887S-968S.

    Carpenter, C, Keim S, Milne W, Meurer W, Barsan W. Thrombolytic therapy for acute ischemic stroke beyond three hours. J Emerg Med. 2010; June 23rd [Epub ahead of print].

    How is a stroke diagnosed? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/diagnosis.html. Updated March 26, 2014. Accessed June 13, 2014.

    Neuroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 15, 2013. Accessed June 13, 2014.

    Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 22, 2014. Accessed June 13, 2014.

    Stroke diagnosis. American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/Diagnosis/Stroke-Diagnosis%5FUCM%5F310890%5FArticle.jsp. Updated November 21, 2012. Accessed June 13, 2014.

    tPA treatments for stroke. Jefferson University Hospitals website. Available at: http://hospitals.jefferson.edu/tests-and-treatments/tpa-treatments-for-stroke. Accessed June 13, 2014.

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