• Diagnosing a Stroke


    How well you recover from a stroke has a lot to do with how quickly your stroke is diagnosed and treatment begins. If you or someone you’re with has the following symptoms, call 911 immediately and tell them you or the person you’re with is having a stroke and you need to go to the closest stroke treatment center.

    If you can get to the hospital or clinic within an hour of your first symptoms, you stand a better chance of being evaluated and treated within the necessary three-hour window for receiving t-PA, one of the most effective ways to treat an ischemic stroke.

    Evaluation by Emergency Personnel and a Stroke Care Team

    Emergency personnel, physicians, and other members of the stroke care will perform and order the following tests to determine as quickly as possible if you are having a stroke, and if you are, the type of stroke (ischemic or hemorrhagic), and the location of the problem:

    • You’ll be asked to describe your symptoms and provide a medical history, family history of illnesses, and a list of any medications that you take.
    • Your doctor will examine you by listening to your heart and checking your pulse, lungs, blood pressure, muscles, nerves, sensation, coordination, reflexes, memory, speech, and thinking.
    • Blood tests will be done to provide more information but also rule out other possible causes of the stroke.
    • Most hospitals will give you a computed tomography (CT) or magnetic resonance imaging (MRI) to determine if the stroke was caused by a blockage in the artery (ischemic stroke) or by bleeding (hemorrhagic stroke).
    • To see how blood is flowing through the carotid artery, your doctor may also order a carotid ultrasound/Doppler scan, and magnetic resonance angiogram (MRA), CT angiogram, or carotid angiogram.
    • Sometimes stroke can be related to a heart problem, so your doctor may also request an echocardiogram to find out for sure.
    • If the stroke is caused by the blockage or narrowing of the arteries to the brain, your doctor may also look at arteries in other parts of the body for signs of coronary artery disease or peripheral artery disease. If arteries are narrowed or blocked in one part of the body, chances are good that plaque is building up in other parts of the body, too, putting you at risk for other problems, such as a heart attack.

    Silent Stroke Diagnosis

    A silent stroke has no symptoms, so the people who have them don’t know it until they have an MRI for some other reason. Just like mini strokes, silent strokes are a warning that you may need treatment to avoid having another, potentially more damaging stroke.

    The Role of Your Primary Care Physician

    Your primary care physician may be the first to determine that you have risk factors for a stroke, heart attack, and other cardiovascular disease. He or she may initiate treatments, such as dietary changes, exercise, and medications to control your risk factors.

    Or your primary care doctor may refer you to a specialist for further diagnosis and treatment. You may be referred to a cardiologist, a doctor who specializes in diseases of the heart and arteries.

    Why a heart doctor? Because 85 percent of strokes are caused by a build-up of fatty deposits, or plaque, inside the vessels—the same condition that causes most heart attacks. Thus, cardiologists’ training in treating blockages in the arteries leading to the heart has also prepared them to treat most strokes. Increasingly, cardiologists are using procedures similar to those they use to stop heart attacks—and they are successfully stopping stroke in its tracks. And, while your cardiologist is treating you to prevent stroke, he or she will also treat you to prevent heart attacks.

    Even if you are referred to a specialist, your primary care doctor will continue to play a role in your care. He or she should continue to be a key member of your care team, working with you to control risk factors and coordinating your care with specialists and various support teams.