Signs and Tests

In diagnosing a stroke, the way the symptoms develop is important. The symptoms may be severe at the beginning of the stroke, or symptoms may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered a complete stroke.

The exam will look for specific neurologic, motor, and sensory deficits, because these often correspond closely to the location of the injury to the brain. An examination may show changes in vision or visual fields, abnormal reflexes or abnormal extent of "normal" reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A "bruit" (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck. There may be signs of atrial fibrillation.

Tests may determine the location and cause of the stroke and rule out other disorders that can cause the symptoms:

• A head CT or MRI of head may be used to rule out bleeding (hemorrhage) or other lesions and define the location and extent of the stroke
• An ECG (electrocardiogram) may be used to determine underlying heart disorders
• An echocardiogram may be used if the cause is suspected to be cardiac embolus
• A carotid duplex (ultrasound) may be used if the cause is suspected to be carotid artery stenosis
• A cerebral (head) arteriography may be used if a disorder involving the blood vessels is suspected

• Platelet aggregation test
• Osmolality
• LDH isoenzymes
• LDH
• Cytometric study
• CSF collection
• CPK isoenzymes
• BERA (brainstem evoked response audiometry)

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