• Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

Quick GuideStroke: Causes, Symptoms, and Recovery

Stroke: Causes, Symptoms, and Recovery

How is a stroke diagnosed?

Time is of the essence since the longer a stroke remains unrecognized and untreated, the longer brain cells are deprived of oxygen-rich blood and the greater number of brain cells that die and cannot be replaced.

  • The American Heart Association and the American Stroke Association recommend that everybody be aware of FAST in recognizing stroke: Face Drooping, Arm Weakness, Speech Difficulty, Time to Call 9-1-1
  • First responders, EMTs and paramedics may use the Cincinnati Prehospital Stroke Scale to recognize a stroke and alert the emergency department to prepare for their arrival. This scale addresses the same three components as the FAST: speech, arm strength, and speech.
  • In the emergency department, nurses and doctors may use the National Institute of Health Stroke Scale to perform a more in depth and standardized neurologic examination.

The clinical diagnosis of stroke is usually made after the health care professional performs a history and physical examination. While speed is important in making the diagnosis, it is also important to learn about the circumstances that brought the patient to be seen. For example, the patient just started slurring words about an hour ago versus the patient has been slurring his words since last evening.

There is urgency to make the diagnosis and determine whether treatment with thrombolytic medications (clot-busting drugs) to “reverse” the stroke is a possibility. The time frame to intervene is narrow and may be as short as 3 to 4 ½ hours after onset of symptoms. For that reason, family members or bystanders may be needed to confirm information, especially if the patient is not fully awake or has a speech deficit.

History may include asking about what symptoms are present, when they began, and if they are improving, progressing, or remaining the same. Past medical history will look for stroke risk factors, medications, allergies, and any recent illnesses or surgeries. Medication history is very important, especially when the patient is taking anticoagulants (examples include warfarin [Coumadin], dabigatrin [Pradaxa], rixaroxiban [Xarelto], apixaban [Eliquis]).

Physical examination includes assessing vital signs and patient wakefulness. A neurologic examination is performed, usually using the standardized stroke scale. Heart, lungs, and abdomen are also assessed.

If an acute stroke is still a consideration, blood tests and CT of the head are indicated. However, the tests are not used to make the diagnosis, but are used to help plan treatment. Nonetheless, a CT is often used to differentiate an ischemic from a hemorrhagic stroke because the treatment plans are quite different.

The CT is used to look for bleeding or masses in the brain and potentially how much brain tissue is experiencing decreased blood supply.

An MRI of the brain may be possibly indicated, but not all hospitals have this technology readily available.

Blood tests may include a complete blood count (CBC), to measure red blood cell count and platelets, electrolytes, blood glucose, and kidney function and blood tests to measure blood clotting function, international normalized ratio (INR), prothrombin time (PT) and partial thromboplastin time (PTT). Other blood tests may be indicated based upon the patient's specific situation.

An EKG may be performed to check the heart's rate and rhythm. The patient is usually placed on a cardiac monitor.

Medically Reviewed by a Doctor on 2/18/2016

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