Stroke Diagnosis

You might wonder if your neurological symptoms are really symptoms of a TIA or a stroke. Sometimes it is obvious to you and your health care team that you are having a stroke or have already had a stroke. But often, it is not so clear. Here are the steps involved in determining whether you have had a stroke or a TIA.

Evaluation of Your Symptoms

Your symptoms are defined as your own feelings that you experience when you are sick.

Symptoms of stroke can include visual changes, speech difficulties, pain, tingling, weakness, dizziness, or spaciness. But only you can feel and experience your own symptoms. Your description of how you are feeling is crucial in a stroke diagnosis. If you are able to describe what is happening to you during a stroke or TIA, that is extremely valuable.

However, in many instances, a stroke can impair your ability to speak or even your awareness of what is going on. It is helpful if you have witnesses who can describe what you were complaining of or what seemed to be occurring prior to your arrival for a medical evaluation.

And sometimes there is no immediate medical history available. Some stroke patients are 'found' passed out or unconscious. In that case, your health care team has to rely more on your current condition without knowing the detailed story of how it evolved over the past hours or past days.

Physical Signs

Your physical examination is the way that your health care team examines your arms, legs, eyes and other body parts as part of your medical evaluation The doctors will check reflexes, muscle strength, eye movements, vision, balance and other neurological functions to determine the signs on your physical examination.

The physical examination portion is the most important part of your stroke evaluation because a stroke occurs deep in the brain in areas that control certain physical and cognitive functions. So, your bodily signs of neurological dysfunction and impairment help determine if you have experienced a stroke, what type of stroke it is, what region of the brain is involved and whether the stroke is getting better or worse. The signs found on a physician examination direct the next steps in a stroke evaluation and help construct the treatment plan.

Imaging Tests

Brain imaging tests are pictures that can characterize the brain's anatomy deep beneath the skull to determine if there is any brain injury. Brain MRI, Brain CT, MR spectroscopy and PET scans are all different methods of using technology to look at the brain. Often, the neurological symptoms you feel and the signs noted on physical examination happen faster than the actual anatomical changes can be detected on brain imaging. Nevertheless, imaging can be helpful in confirming a stroke diagnosis and in directing a safe and maximally effective medical treatment plan.

Brain imaging tests can help distinguish between a stroke and other similar neurological problems such as seizures, Parkinson's disease and dementia, all of which can be easily mistaken for a stroke.

Blood Tests

Less commonly used than imaging in stroke diagnosis, blood tests can help in diagnosing blood disorders that lead to stroke or in uncovering unusual causes of stroke and in determining the correct dose of medications such as blood thinners.

Usually, blood tests are not the most urgent part of a stroke diagnosis, but they can be important in developing a long-term plan. Often, stroke risk factors, such as high cholesterol are diagnosed through blood tests. This can help with prevention of future strokes and TIAs.

How Long Does a Stroke Diagnosis Take?

If you have a stroke, you might be diagnosed within minutes of being seen by a health care professional. But sometimes, stroke diagnosis can be a bit tricky. Often, if there is not a neurologist available, a confirmation of stroke diagnosis will have to wait or can be obtained by telemedicine.

Generally, it takes up to an hour to reliably diagnose a stroke, but some unusual stroke syndromes can take days or even weeks. Throughout the process, you and your loved ones should remember that it is important for you to discuss your questions with your medical team and that you will benefit if you learn as much as you can about stroke, treatment, prognosis, and recovery.

Sources

Minor ischemic stroke: Triaging, disposition, and outcome, Yaghi S, Willey JZ, Khatri P, Neurology Clinical Practice, 2016 Apr;6(2):157-163

Ropper, Allan, Samuels, Martin, Klein, Joshua, Principles of Neurology, 10th Edition, McGraw-Hill, 2014

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