Spotting Stroke: Vigilant Doctors Save Lives

how can my doctors office look for stroke

A stroke is a life-threatening medical emergency that occurs when there is an interruption to the blood flow to the brain. If you suspect that you or someone you know is having a stroke, it is crucial to seek immediate medical attention by calling an ambulance. The tests for stroke usually begin in the ambulance, and the faster these tests are done, the better the chances of recovery without disability. Doctors will perform a combination of physical and neurological examinations, imaging tests, and blood tests to determine whether a stroke has occurred, its type, cause, and location. Imaging tests such as CT scans, MRIs, ultrasounds, and angiograms provide visual information about the brain and blood vessels, while blood tests help identify underlying causes such as clotting issues or heart problems.

Characteristics Values
Diagnostic tests Physical exam, blood testing, CT scan, MRI, ECG, EEG
Symptoms Loss of balance, loss of vision, muscle weakness on one side, loss of speech, severe headache
Types Ischaemic stroke, haemorrhagic stroke, transient ischaemic attack (TIA)

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CT, MRI and ultrasound scans to check the brain

If your doctor suspects you have had a stroke, they will want to determine the type of stroke, its cause, the part of the brain affected, and whether there is bleeding in the brain. To do this, they will order a series of tests, including blood tests, an electrocardiogram, and imaging tests such as a CT, MRI, or ultrasound scan.

CT Scans

Computed tomography (CT) scans are often the first test used after a suspected stroke as they are readily available in most major hospitals and can provide images quickly. CT scans use X-rays to capture clear, detailed pictures of the brain from multiple angles. They can show whether there is bleeding in the brain or damage to the brain cells, helping doctors identify the type of stroke and rule out other potential causes of stroke symptoms, such as tumours. CT scans can also detect blood clots and infections, and any abnormalities in the brain, such as dying or dead tissue due to a loss of blood flow.

MRI Scans

Magnetic resonance imaging (MRI) may be used instead of, or in addition to, a CT scan. MRI scans use magnets and radio waves to create images of the brain. They can identify changes in brain tissue and damage to brain cells, and are more accurate than CT scans as they are more sensitive and can detect even tiny abnormalities. MRI scans can also show any bleeding or blood flow problems and rule out other issues such as tumours. However, MRI scans take longer than CT scans and are not as readily available, so they may not be the best choice in emergency situations.

Ultrasound Scans

Ultrasound scans use sound waves to create pictures of the carotid arteries, which supply blood to the brain. They are often used in conjunction with a CT or MR angiogram to show whether plaque has built up in the arteries and is blocking blood flow to the brain. One type of ultrasound scan is the trans-cranial Doppler (TCD) ultrasound, which helps doctors find out which artery in the brain is blocked.

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Electrocardiogram (ECG/EKG) to check the heart

An electrocardiogram (ECG or EKG) is a quick, non-invasive, and painless test that can be used to detect and record the electrical activity of your heartbeat. It can help your doctor find out if you have atrial fibrillation or have had a heart attack, which are two common causes of stroke.

During an ECG/EKG test, temporary electrodes are placed on your chest and limbs to monitor, track, and document your heart's electrical activity, which controls your heartbeat. A computer then translates this information into a wave pattern that your doctor can interpret. The test can be performed while you are lying down and resting, or while you are exercising as part of a stress test.

The wave pattern produced by the ECG/EKG will show the rate and rhythm of the contractions in the upper and lower chambers of your heart. The first wave, called the "P wave," is made by the upper chambers (atria) of your heart. The next wave, the "QRS complex," is created by the lower chambers (ventricles). The final wave, or "T wave," represents your heart at rest or recovering after beating.

By measuring the time intervals on the ECG/EKG, your doctor can determine how long the electrical wave takes to pass through your heart. This can indicate if the electrical activity is normal or slow, fast, or irregular. Additionally, by measuring the amount of electrical activity passing through the heart muscle, your doctor may be able to identify if parts of your heart are damaged, too large, or overworked.

An ECG/EKG is a valuable tool in diagnosing heart problems and evaluating your heart health. It is often used in conjunction with other tests and imaging techniques to diagnose a stroke and determine its cause and location in the brain.

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Blood tests to check clotting, glucose and more

Blood tests are an important tool for doctors to determine the cause of stroke symptoms and the type of stroke that has occurred. While there is no single blood test that can diagnose a stroke, a series of blood tests can be used to assess the overall health of the patient's blood and identify any underlying conditions that may have contributed to the stroke. Here are some common blood tests that may be performed:

Complete Blood Count (CBC)

This test measures the overall health of the patient's blood and helps diagnose infection, anemia, clotting problems, or other blood-related issues. It includes a check for platelet levels, which are cells that aid in blood clotting, and electrolyte levels, which can indicate kidney function.

Blood Clotting Tests

Also known as a coagulation panel, these tests measure how quickly the patient's blood clots. If the blood clots too quickly, it may indicate an ischemic stroke caused by a blood clot. On the other hand, if the blood clots too slowly, it may suggest a hemorrhagic stroke caused by bleeding.

Blood Glucose Test

This test measures the amount of glucose (sugar) in the patient's blood. Hyperglycemia, or high blood glucose levels, is a common complication in diabetic patients and can increase the risk of stroke. Additionally, low blood sugar can also cause stroke-like symptoms, even in the absence of a stroke. Therefore, this test helps determine if the patient's symptoms are related to blood glucose levels.

Cholesterol Tests

High cholesterol is a known risk factor for stroke. This test examines whether high blood cholesterol levels might have contributed to the patient's stroke.

C-Reactive Protein Test and Blood Protein Test

These tests detect substances in the blood that indicate swelling or inflammation. Damage to arteries, which can lead to stroke, is one of the causes of inflammation in the body.

Serum Electrolytes Test

This test assesses the levels of electrolytes in the blood, which are substances that carry an electric charge. Electrolyte imbalances can cause stroke-like symptoms such as confusion or muscle weakness. Additionally, electrolyte levels can indicate dehydration, which can lead to confusion or tiredness.

In addition to these blood tests, doctors may also perform imaging tests such as CT scans, MRIs, and ultrasounds to visualize the brain and detect any damage or blockages. These tests, along with a physical and neurological examination, help doctors make an accurate diagnosis and determine the best course of treatment for the patient.

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Carotid artery disease check with a stethoscope

Carotid artery disease, or carotid artery stenosis, is a condition that can lead to stroke. It is caused by the buildup of fatty substances, cholesterol, calcium, and other waste products inside the artery lining, known as atherosclerosis. This buildup narrows the arteries and decreases blood flow to the brain, increasing the risk of stroke.

When examining a patient for carotid artery disease, a doctor will place a stethoscope over the carotid artery to listen for a sound called a bruit (pronounced brew-ee). This whistling or murmuring sound is produced when blood passes through a narrowed artery. The presence of a bruit can indicate carotid artery stenosis, but it is not always present, as an artery may be diseased without producing this sound.

The carotid arteries are located on either side of the neck and supply blood to the brain, face, and head. During a carotid artery examination, a doctor will place a stethoscope on the patient's neck over these arteries to listen for any abnormal sounds. If a bruit is detected, it may indicate that the artery is narrowed due to atherosclerosis.

In addition to the stethoscope examination, doctors may also order imaging tests such as an ultrasound, computed tomography angiography (CTA), or magnetic resonance angiography (MRA) to confirm the diagnosis and determine the severity of the blockage. These tests can provide visual images of the carotid arteries and help doctors assess the blood flow and any blockages or narrowings.

It is important to detect carotid artery disease early as it can increase the risk of stroke. Stroke is a medical emergency, and prompt diagnosis and treatment are crucial to prevent severe complications or death.

Stroke Diagnosis: CT or MRI Scan?

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Physical exam to check for numbness, weakness, speech and vision issues

A stroke is a medical emergency, and tests to diagnose it usually begin in the ambulance before the patient arrives at the hospital. The goals of these tests are to determine whether the patient has had a stroke, what type of stroke it was, and what caused it. This information will help doctors plan the patient's treatment.

Physical Exam

A physical exam will be carried out by an ambulance worker or a doctor. This includes taking the patient's blood pressure and checking for mental alertness, numbness or weakness, or trouble speaking, seeing, or walking.

Numbness

Sensory input from different parts of the body can change after a stroke. Survivors may experience feelings of being wet or underwater, irregularities in feeling temperature, or difficulty detecting the position of a limb. To recover from numbness, new connections have to be made to put new, undamaged cells in control of the body part(s) where function has been lost.

Weakness

Weakness can be identified by checking the patient's blood pressure and mental alertness.

Speech Issues

Communication problems are very common after a stroke. Around one-third of stroke survivors experience aphasia, dysarthria, or apraxia of speech. Aphasia affects your ability to speak, understand what others say, read, and write. Dysarthria happens when you're not able to control the muscles in your face, mouth, and throat very well, so it's difficult to speak clearly. Speech apraxia is when you can't move the muscles in your face, mouth, or throat in the right order when speaking.

Vision Issues

Vision problems after a stroke can affect your daily life in many ways. You could find it harder to read, shop, or watch television. You may struggle to get around or feel less confident about going out. You may need support returning to work, such as help with travel or new ways of doing your job. It’s not always obvious right away that your vision is affected, so it’s important to have your vision checked after a stroke.

Frequently asked questions

The first steps to diagnosing a stroke are to perform a physical and neurological exam. This involves asking the patient or their family about their symptoms and medical history, taking their blood pressure, and checking for mental alertness, numbness or weakness, or trouble speaking, seeing, or walking.

Imaging tests that can be used to diagnose a stroke include:

- Computed tomography (CT) scan

- Magnetic resonance imaging (MRI)

- CT or MR angiogram

- Carotid ultrasound

- Trans-cranial Doppler (TCD) ultrasound

- Electroencephalogram (EEG)

There is no single blood test that can diagnose a stroke, but a series of blood tests can be used to determine the cause of stroke symptoms. These include:

- Complete blood count (CBC)

- Serum electrolytes

- Blood clotting tests

- Heart attack tests

- Thyroid tests

- Blood glucose tests

- Cholesterol tests

- C-reactive protein test and blood protein test

Other tests that can be used to diagnose a stroke include an electrocardiogram (ECG or EKG) to check the patient's heart, and a lumbar puncture (spinal tap) if the imaging scan does not find any bleeding in the brain but a hemorrhagic stroke is still suspected.

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