Spotting Stroke Symptoms: What To Look For

how can a stroke be detected

A stroke is a medical emergency that occurs when the flow of blood to the brain is interrupted. It is important to be able to detect a stroke as immediate treatment can save lives and reduce disability. There are several ways to detect a stroke, including the F-A-S-T test, which is an easy way to remember the signs: checking if one side of your face sags, if one of your arms droops, and if your speech sounds strange or slurred. If you notice any of these symptoms, you should call 911 right away. In addition to this test, doctors will also perform physical and neurological exams, imaging tests such as CT and MRI scans, and blood tests to determine if a stroke has occurred and what type it is.

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Physical and neurological exam

A physical and neurological exam is an essential part of stroke detection and diagnosis. This exam involves an evaluation of the patient's nervous system, including the brain, spinal cord, and nerves. The extent of the exam will depend on factors such as the patient's age, condition, and the specific problems they are experiencing. Here is a detailed breakdown of the physical and neurological exam:

  • Mental Status: The patient's level of awareness and interaction with the environment is assessed. This involves observing the patient's speech and their ability to make sense while talking. The patient may be asked about their orientation to person, place, and time.
  • Motor Function and Balance: The patient's strength and coordination are evaluated. This may involve having the patient push and pull against the examiner's hands with their arms and legs. Balance is assessed by observing the patient's stance and gait and testing their ability to stand with their eyes closed while being gently pushed.
  • Sensory Exam: The patient's ability to feel sensations is tested using various instruments like dull needles, tuning forks, or alcohol swabs. The examiner touches different parts of the patient's body, and the patient identifies the sensation (hot/cold, sharp/dull, etc.).
  • Reflexes: Reflexes are examined using a reflex hammer at different points on the body. In newborns and infants, specific primitive reflexes, such as the Babinski reflex and Moro's reflex, are evaluated.
  • Evaluation of Cranial Nerves: The 12 main nerves of the brain, known as cranial nerves, are assessed to determine brain function. This includes testing smell, vision, pupil response, eye movement, facial sensation, taste, hearing, swallowing, and speech.
  • Coordination and Gait: The patient's coordination and gait are assessed. They may be asked to walk normally or in a straight line and perform tasks like touching their nose with their eyes closed.

These physical and neurological examinations provide valuable information about the patient's nervous system and brain function, aiding in the detection and diagnosis of a stroke.

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Imaging tests: CT, MRI, ultrasound, angiogram, etc

Imaging tests are crucial for diagnosing a stroke and determining its type, location, and extent. Here's an overview of the different imaging tests used:

Computed Tomography (CT) Scan:

CT scanning combines special X-ray equipment with sophisticated computers to produce multiple images of the inside of the head. It can detect bleeding or damage in the brain, helping physicians identify a stroke caused by a blood clot or bleeding. CT angiography (CTA) and CT perfusion (CTP) can be used in conjunction with CT to visualise the cerebral blood vessels and blood flow, aiding in the diagnosis of stroke and guiding treatment decisions.

Magnetic Resonance Imaging (MRI):

MRI utilises a powerful magnetic field, radio frequency pulses, and a computer to generate detailed images of the brain and its tissues. It can detect brain tissue changes and is more effective than CT in identifying the specific areas of the brain affected by a stroke. MRI can also be used in MR angiography (MRA) to image the cerebral vessels and MR perfusion (MRP) to produce images of blood flow.

Cerebral Angiography:

Cerebral angiography is a test that uses X-rays, CT, or MRI, along with a contrast material, to create detailed images of the major blood vessels in the brain. It helps detect or confirm abnormalities such as blood clots or narrowed arteries.

Ultrasound:

Ultrasound imaging employs high-frequency sound waves to visualise the inside of the body. Carotid ultrasound is used to examine the carotid arteries, which supply blood to the brain, and can detect plaque buildup, clots, or blockages. Doppler ultrasound, a specialised form of ultrasound, provides detailed images of blood vessels and information on blood flow.

CT or MR Angiogram:

An angiogram is an X-ray movie of the blood vessels and blood flow. A CT angiogram combines CT scanning with angiography, while an MR angiogram uses MRI technology. These techniques provide a detailed visualisation of the blood vessels after a stroke, helping identify blockages or abnormalities.

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Blood tests

One common blood test is a complete blood count (CBC), which measures the overall health of the blood and helps diagnose infection, anaemia, clotting problems, or other blood problems. Blood tests can also check serum electrolytes, which carry an electric charge in the blood. An electrolyte problem can cause stroke-like symptoms such as confusion or muscle weakness.

Blood clotting tests are also used to measure how quickly blood clots. If the blood clots too quickly, it could indicate an ischemic stroke caused by a clot. If the blood clots too slowly, it could indicate a hemorrhagic stroke caused by bleeding.

Other blood tests may be done to check for heart attack or thyroid problems, as these can also increase the risk of stroke. Blood glucose tests are important as low blood sugar can cause symptoms similar to a stroke. Cholesterol tests are also common, as high blood cholesterol could lead to a stroke.

C-reactive protein tests and blood protein tests are used to look for substances in the blood that the body releases in response to swelling or inflammation. This can help doctors understand a patient's stroke risk and determine how to treat it.

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Electrocardiogram (ECG or EKG)

An electrocardiogram (ECG or EKG) is a test that can help determine whether a stroke was caused by heart problems. It does so by checking and recording the heart's electrical activity, which is coordinated by natural electrical impulses that direct the contraction of the heart's different parts, keeping blood flowing as it should.

During an ECG, electrodes (small, plastic patches) are placed on the chest, arms, and legs. These electrodes are connected to an ECG machine by lead wires, which measure, interpret, and print out the electrical activity of the heart. The procedure is non-invasive, meaning nothing is injected into the body, and it is simple, quick, and easy to perform.

An ECG can be used to detect and record the heart's electrical activity in stroke patients, helping doctors determine if atrial fibrillation caused the stroke. Atrial fibrillation is a type of irregular heartbeat that can lead to the formation of blood clots, which can travel to the brain and cause a stroke. ECG monitoring by emergency medical services can also detect cardiac arrhythmia in stroke patients, aiding in-hospital evaluation and pre-hospital care.

In addition to detecting atrial fibrillation, an ECG can identify other heart problems that may have contributed to the stroke, such as a recent or ongoing heart attack, abnormal heart rhythms (arrhythmias), coronary artery blockage, areas of damaged heart muscle, enlargement of the heart, and inflammation of the sac surrounding the heart (pericarditis). It can also help detect non-heart conditions, such as electrolyte imbalances and lung diseases, which may be related to the stroke.

While an ECG is a valuable tool in stroke detection, it has its limitations and should be used alongside other tests such as CT scans, MRIs, and ultrasounds. It is often used to monitor the heart during physical activity or as a stress test to assess the heart's response to exercise.

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Lumbar puncture

A lumbar puncture (LP) or spinal tap is a procedure that can be used to diagnose or treat a condition. During the procedure, a hollow needle is inserted into the subarachnoid space, the area surrounding the spinal column in the lower back, to withdraw cerebrospinal fluid (CSF) or inject medicine.

CSF is a clear fluid that surrounds and cushions the brain and spinal cord, and it is essential for maintaining balance in the nervous system. The most common reason for a lumbar puncture is to remove a small amount of CSF for testing to aid in the diagnosis of various disorders. The clarity and colour of the fluid are checked, and it is tested for red and white blood cells, protein, and glucose. The fluid is also examined for the presence of bacteria, viruses, or abnormal cells.

A lumbar puncture can be helpful in diagnosing several diseases and disorders, including meningitis, encephalitis, certain cancers involving the brain and spinal cord, subarachnoid haemorrhage, Reye syndrome, myelitis, neurosyphilis, Guillain-Barré syndrome, demyelinating diseases, and pseudotumor cerebri. It can also be used to measure the pressure of the CSF and to inject medicine directly into the spinal cord, such as spinal anaesthetics, contrast dye for X-ray studies, or chemotherapy drugs.

While a lumbar puncture is an important diagnostic tool, it does carry some risks. Complications may include CSF leakage from the needle insertion site, leading to headaches; a slight risk of infection; short-term numbness of the legs or lower back pain; and bleeding in the spinal canal. Patients should discuss any concerns with their healthcare provider before the procedure and follow specific instructions for preparation and aftercare.

Frequently asked questions

A stroke is a medical emergency and it is important to seek immediate medical attention if you think you or someone you know is having a stroke. Tests for stroke usually start in the ambulance on the way to the hospital. An ambulance worker or doctor will ask about symptoms and medical history, and perform a physical and neurological exam. This includes checking for mental alertness, numbness or weakness, or trouble speaking, seeing or walking.

There are two main types of stroke: ischaemic and haemorrhagic. An ischaemic stroke is caused by a blood clot blocking blood flow to the brain and is the most common type of stroke. A haemorrhagic stroke is caused by a blood vessel bursting and allowing blood to leak into the brain. There is also a transient ischaemic attack (TIA or mini-stroke), which is when stroke symptoms last less than 24 hours.

Imaging tests such as CT scans, MRIs, and ultrasounds can be used to detect a stroke. CT scans use X-rays to take pictures of the brain and can show bleeding, damage to brain cells, and other problems that can cause stroke-like symptoms. MRIs use magnets and radio waves to create a detailed picture of the brain and can show brain changes caused by a stroke sooner than a CT scan. Ultrasounds use sound waves to create pictures of the carotid arteries that supply blood to the brain and can show if plaque has built up and is blocking blood flow.

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