Stroke Symptoms and Diagnosis

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A stroke is a dangerous event. The longer a stroke continues, the more likely it is that you will end up with permanent and irreversible brain damage. It is vital that you and your family become familiar with the symptoms and signs of a stroke so that you can recognize when one is occurring. Immediately call 911 or a similar emergency telephone number if you believe that a loved one is having a stroke. The faster you are able to get your loved one (or yourself) medical care, the better the odds are for reducing subsequent brain damage.

Some of the more common symptoms of stroke include:

  • Numbness in the face or limbs on one side of the body
  • Sudden, painless weakness on one side of the body.
  • Sudden confusion
  • Sudden trouble in understanding language.
  • Sudden slurring of the speech or difficulty speaking.
  • Trouble walking, sometimes accompanied by loss of balance.
  • Sudden onset of a severe headache with no apparent cause.
  • Sudden painless loss of vision in one or both of eyes.
  • Drooping of one side of the face

While the above symptoms frequently indicate stroke, your doctor will administer additional tests to confirm the diagnosis. These confirming tests basically provide your doctor with information concerning what type of stroke has occurred (if that is truly the case), the location of the damage, and how freely the blood is now flowing within the vessels around the brain.

The ideal goal is to start treatment for a stroke within 3 hours of the onset of symptoms in order to minimize damage. For this reason, a stroke is considered an emergency medical situation. Therefore, doctors will move quickly to diagnose a suspected stroke using one or several of the following methods:

  • CT (or CAT) Scan. CT-scans are one of the most commonly used diagnostic tests for stroke, as they are relatively quick, and easy to perform in most medical centers. A CT scan uses radiation to create an image of the brain in a manner similar to a conventional x-ray. Unlike an x-ray, however, a CT scan can be used to create cross-sectional images (which are more detailed than x-rays). Doctors often use CT scans to make certain that a hemorrhagic stroke has not occurred. Once doctors have verified that there is no brain bleeding, medication can be used to dissolve remaining clots (which can cause an ischemic stroke).
  • MRI. MRI, or magnetic resonance imaging, uses magnetic fields to create detailed images of the body and brain tissue. MRI provides a more detailed brain image than does CT scanning, allowing for more sensitive detection of small changes. For example, MRI is more accurate at determining if a stroke has occurred, especially in identifying the brain cell changes that accompany ischemic strokes. MRI has some disadvantages, such as being less available, taking longer to complete, and costing more than CT scans.
  • Angiography. An angiogram provides an image of the blood flow in a person's arteries. A special radioactive dye is injected into the patient's bloodstream prior to performing an x-ray. This dye stands out on the resulting x-ray image, providing a view of blood flow in a specific area. Angiography is currently the best method for determining the location of a stroke in the brain (i.e., which blood vessel) as well as the type of stroke (ischemic or hemorrhagic), but is typically reserved for times when there is uncertainty that is not clarified by a CT or MRI scan.
  • Ultrasound. In an ultrasound test, sound waves are aimed at areas of the neck or head, where blood flow may be abnormal. The images provide doctors with a picture of blood flow through these arteries. Ultrasound is quick and painless, but is not the most accurate method for diagnosing whether a stroke occurred. However, ultrasound can be helpful for identifying the causes of stroke such as plaques, carotid artery stenosis (blockage), or emboli (blood clots that have broken loose). Also, ECHO's (i.e., ultrasounds of the heart) are important for evaluating atrial fibrillation (described previously, click here to return to that description) and identifying blood clots in the heart that can also cause emboli.

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