Diagnosis

Diagnosing a stroke promptly and accurately is very important. If you suspect someone you know may be having a stroke, call 911 immediately and make a note of the time that symptoms first began. Remember to act FAST!

There are many ways for your emergency team to diagnose a stroke, including:

  • Medical history. Your doctor will ask about your prior medical history, any medications you take, and stroke risk factors such as family history or smoking.

  • Physical exam. During your physical exam, your doctor will assess your balance, coordination, and mental alertness. Your doctor will also check for other symptoms of stroke, such as numbness, weakness, or paralysis in your legs, arms, or face.

  • Computed tomography (CT) scan. Your doctor may order a CT scan of your brain to determine if there is any bleeding in your brain as a result of a stroke or if there are any other abnormalities that may be causing stroke-like symptoms, such as a brain tumor.

  • Magnetic resonance imaging (MRI). An MRI uses radio waves and magnetic fields to create detailed images of your body. An MRI of your brain may be ordered to determine if there is any damage to your brain tissue as the result of a stroke.

  • Carotid ultrasound. Carotid ultrasound uses sound waves to create detailed images of your carotid arteries in your neck, which supply blood to your brain. A carotid ultrasound can show plaque buildup or blockage of your carotid arteries.

  • Cerebral or carotid angiogram. Your doctor will make a small incision leading to one of your arteries, usually in your thigh. Your doctor will then insert a small hollow tube called a catheter into your artery and guide the catheter to the major arteries in your neck. Once in position, your doctor will inject a dye that makes the arteries in your neck and/or brain visible under x-ray imaging to check for signs of hemorrhaging or blockage.

  • Echocardiogram. An echocardiogram uses sound waves to create images of your heart as well as any clots that may have formed in or around your heart. Your doctor may use an echocardiogram to find the source of clots that may have traveled to your brain and caused a stroke.

  • Electrocardiogram (EKG). An EKG measures and reports your heart’s electrical activity and can determine if your heart is functioning well. An EKG may be used to diagnose heart complications that led to a stroke, such as atrial fibrillation (A-fib).

  • Blood test. Your doctor may order blood tests to determine the time it takes your blood to clot, assess whether you have an infection, and monitor your blood sugar.

Treatment

Stroke treatment varies depending on the type of stroke and other factors. After performing an exam and diagnostic tests, your doctor will identify the type of stroke you are having and provide the most effective treatment.

Ischemic Stroke Treatment

Treatment for ischemic stroke means removing the clot that is causing the blockage. The approach varies depending on a number of factors, including how long you have had symptoms. Treatment options include:

  • Clot-busting medication (tPA). Tissue plasminogen activator (tPA) breaks apart the clot and restores blood flow to your brain. If you are medically unable to receive tPA, your doctor may choose to give you anticoagulants (blood thinners) or antiplatelet medicine to prevent the clot from growing larger.

  • Intra-arterial thrombolysis. During this procedure, a long, flexible tube, or catheter, is inserted through an artery in your groin to deliver tPA, a clot-busting medicine, directly to the area of your brain where the clot is located.

  • Mechanical clot removal in cerebral ischemia (MERCI). During MERCI, a catheter carrying a small device is threaded through a carotid artery to physically remove the clot and restore blood flow.

  • Carotid endarterectomy. Carotid endarterectomy is a surgical procedure to remove plaque from inside your carotid artery through an incision in your neck.

  • Carotid angioplasty and stenting. During this procedure, a catheter is threaded through an artery, usually in your groin, and guided to the site of the blockage in your carotid artery. Once in place, your doctor will inflate a balloon to widen your artery and restore blood flow. A small, hollow tube called a stent will then be placed to keep your artery open.

Hemorrhagic Stroke Treatment

Treatment for hemorrhagic stroke means stopping the bleeding in your brain and reducing the pressure it is causing. Treatment options include:

  • Medication. If you take blood-thinners or antiplatelet drugs, your doctor will give you medications to counter the effects of these medicines and allow your blood to clot. Other medications may include drugs to reduce blood pressure and intracranial pressure or prevent vasospasms and seizures.

  • Endovascular embolization (coiling). Endovascular coiling is used to plug or block a ruptured aneurysm.

  • Surgical clipping. During this procedure, a clip is placed on an aneurysm to stop blood flow.

  • Arteriovenous malformation (AVM) repair. This procedure is used to fix the deformities in your blood vessels that led to a hemorrhagic stroke.