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Diagnosing Stroke

When you show symptoms of a stroke, the emergency team will need to evaluate the type of stroke you are having and the areas of your brain affected by the stroke.

Your doctor may use several tests to determine your risk of stroke, including:

  • A review of medical history
  • Physical and neurological examination
  • Laboratory (blood) tests
  • Diagnostic tests (radiologic)

Diagnostic tests are used to examine how the brain looks, works and obtains its blood supply. They can outline the injured area of the brain and sometimes determine the cause of the stroke.

Diagnostic tests

Diagnostic tests that may be ordered include:

  • CT (computerized tomography) scan is a test that uses radiation to create a picture of the brain. It is ordered first when diagnosing a stroke.
  • CTA (CT angiography) uses intravenous contrast dye to show major arteries supplying the brain blood and detect the type and location of a stroke.
  • CTP (CT perfusion) is a specialized CT test used to evaluate blood flow to brain tissue when an ischemic stroke is suspected.
  • MRI (magnetic resonance imaging) is a test that uses a large magnetic field to create detailed image of the brain. The image produced by MRI is sharper and more detailed than a CT scan and can be used to diagnose small, deep injuries.
  • MRA (MR angiography) uses intravenous contrast dye to view the blood flow of the head and neck. The MRA allows the doctor to look at smaller blood vessels to detect the type and location of a stroke.
  • Cerebral angiogram (arteriogram) is the most definitive way to view the blood vessels of the brain and provides the highest level of detail. In addition to providing high-resolution images, an angiogram also provides information about the blood flow in your brain. For the procedure, a small catheter is placed through an artery in the wrist or groin and carefully moved up through the main blood vessels in the chest and neck. Contrast dye then is injected and X-ray images are taken to construct a 3D view of your vessels.
  • Echocardiogram is a test that uses sound waves to create a moving picture of the heart. It can provide pictures of the heart’s valves and chambers and help evaluate the pumping action of the heart.
  • TEE (transesophageal echocardiogram) is a test that uses sound waves from a transducer that is placed in the esophagus to produce a very detailed picture of the heart, especially the back of the heart.
  • EEG (electroencephalogram) is a diagnostic test that uses small metal discs placed on the scalp to pick up electrical impulses. These electrical impulses can show areas of brain injury and may help identify seizure activity.
  • Carotid ultrasound (Doppler testing) is a blood flow test that uses ultrasound to provide detailed information about the condition of the carotid and vertebral arteries that supply blood to the brain.