Diagnostic Tests for Stroke
Stroke: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Stroke
includes:
Stroke Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Stroke:
Stroke Diagnosis: Book Excerpts
Tests and diagnosis discussion for Stroke:
NINDS Stroke Information Page: NINDS (Excerpt)
Stroke is diagnosed through several techniques: a
short neurological examination, blood tests, CT scans, MRI scans, Doppler
ultrasound, and arteriography.
(Source: excerpt from NINDS Stroke Information Page: NINDS)
Stroke: NWHIC (Excerpt)
Before a stroke can be treated, diagnostic tests must be performed.
Health care providers must find out what kind of stroke it is to treat it
correctly. A person thought to be having a stroke may have a neurological
exam, blood tests and an electrocardiogram.
Other kinds of tests used in diagnosing stroke include:
· Imaging tests that give a picture of the brain. These include CT
(computed tomography) scanning, sometimes called CAT scans, and
MRI (magnetic resonance imaging) scanning. CT scans are
particularly useful for determining if a stroke is caused by a blockage or
by bleeding in the brain.
· Electrical tests such as EEG (electroencephalogram) and an evoked
response test to record the electrical impulses and sensory processes of
the brain.
· Blood flow tests, such as Doppler ultrasound tests, to show
any changes in the blood flow to the brain.
(Source: excerpt from Stroke: NWHIC)
Stroke Prevention and Treatment - Age Page - Health Information: NIA (Excerpt)
Doctors make an early diagnosis by studying symptoms,
reviewing the patient's medical history, and performing tests such
as a computerized tomography (CT) scan-a 3-dimensional x-ray of the
brain. (Source: excerpt from Stroke Prevention and Treatment - Age Page - Health Information: NIA)
Diagnosis of Stroke: medical news summaries:
The following medical news items
are relevant to diagnosis of Stroke:
Diagnostic Tests for Stroke: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Stroke.
DYSARTHRIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The yield for diagnoses of dysarthria is high for a blood alcohol level and urine drug screen. If the dysarthria is intermittent, an EEG and Tensilon test or acetylcholine receptor antibody titer should be done. If transient ischemic attacks are suspected, a carotid scan should be done, but the only way to completely exclude this possibility is by doing four-vessel cerebral angiography. A CT scan or MRI should be done in all cases of persistent dysarthria. A neurologist can help decide which study would be most appropriate. If Wilson's disease is suspected, a test for serum copper and ceruloplasmin should be done. A spinal tap may help diagnose multiple sclerosis and intracranial hemorrhage.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Dysarthria:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Explore dysarthria completely. When did it begin? Has it gotten better? Speech improves with resolution of a transient ischemic attack, but not in a completed stroke. Ask if dysarthria worsens during the day. Then obtain a drug and alcohol history. Also, ask about a history of seizures. Check dentures for a proper fit.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Dysarthria:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Explore dysarthria completely. When did it begin? Has it gotten better? Speech improves with resolution of a transient ischemic attack, but not in a completed stroke. Ask if dysarthria worsens during the day. Then obtain a drug and alcohol history. Also, ask about a history of seizures. Observe dentures for a proper fit.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Stroke:
Physical examination (PE)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General examination. This should include vital signs (notably blood pressure), Mini-Mental Status Examination, and an examination of the eyes, including funduscopic. A screening neurologic examination of cranial nerves, coordination, muscle strength, sensation, deep tendon, reflexes, and gait is recommended.
B. Additional PE. Evaluate the heart (arrhythmia, mitral stenosis) and vascular system (carotid bruits), and palpate the scalp and neck (trauma and migraine) and superficial temporal arteries (arteritis).
Testing
A. Clinical laboratory tests. In most instances, laboratory tests are not helpful in the acute assessment. Laboratory tests that may be suggested by the clinical history and PE include blood sugar, coagulation studies (prothrombin, partial thromboplastin times), platelet count, antiphospholipid antibodies, protein S, protein C, antithrombin III, and toxicology screens (cocaine, amphetamines). C-Reactive protein can be of prognostic significance (4). Additional tests may be relevant, depending on the history and PE, including electrocardiogram, cardiac monitoring, electroencephalogram, and spinal tap.
B. Diagnostic imaging. In most instances, diagnostic imaging should include an emergent cerebral CT scan of the brain to rule out abscess, tumor, or hemorrhage. A magnetic resonance imaging scan is a better test for aneurysm, arteriovascular malformation, or tumors. Other tests can include transthoracic or esophageal echocardiogram, duplex carotid ultrasonography, cerebral angiography, and magnetic resonance angiography.
Diagnostic assessment.
The key to the diagnosis of stroke is the duration of neurologic event coupled with the signs and symptoms. The CT scan rules out other serious pathology that can mimic stroke. Specifically, laboratory tests can aid in the workup and are directed by the history and physical examination.
References
1. Schneck MJ. Acute stroke: an aggressive approach to intervention and prevention. Hosp Med 1998;34(1):11–28.
2. Graffagnino C, Itaachinski V. Stroke (brain attack). In: Dambro MR, ed. Griffith’s 5-minute clinical consult, 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 1999:1014–1015.
3. Nendaz MR, Sarasin FP, Junod AF. Preventing stroke recurrence in patients with patent foramen ovale: antithrombotic therapy, foramen closure, or therapeutic abstention? A decision analytic perspective. Am Heart J 1998;135(3):532–541.
4. Muir KW, Weir CJ, Alwan W. C-Reactive protein and outcome after ischemic stroke. Stroke 1999;30:981–985.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Stroke Syndromes:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Brain ischemia leading to stroke may be due to embolism from carotid or cardiac sources, systemic hypoperfusion, or in situ thrombosis. Embolic strokes occur suddenly with maximal focal deficits at the onset. Rapid improvement favors an embolic TIA. Thrombosis symptoms fluctuate in a stepwise pattern. Intracerebral hemorrhage progresses gradually over minutes to hours. Aneurysmal subarachnoid hemorrhage occurs in an instant, and focal brain dysfunction is usually absent. Strokelike symptoms due to migraine are recognized by a headache, epiphenomena such as anorexia/nausea and photophobia, and occurrence in younger patients.
A TIA proceeds to stroke in 10% to 40%. Risk is especially high in “crescendo TIA,” which is usually caused by an ulcerated carotid plaque. Amaurosis fugax (“a shade coming down” or transient monocular loss of vision) is a classic presentation. Amaurosis fugax, an anterior circulation event, should be distinguished from transient hemianopsia, a posterior circulation event. An asymptomatic carotid bruit is an imperfect indicator of carotid stenosis and subsequent stroke risk, with an annual risk of an ipsilateral stroke not preceded by a TIA of 1% to 3% per year.
Examination of the optic fundus may reveal a cholesterol crystal, white platelet-fibrin or red clot emboli. Subhyaloid hemorrhage often accompanies a subarachnoid or intracerebral hemorrhage. A red patch with a white center (Roth spot) may be seen in bacterial endocarditis. With occlusion of the carotid artery, the iris may appear speckled and the ipsilateral pupil dilated and poorly-reactive.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Aphasia/Dysarthria:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Dysarthria:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Perform a complete neurologic examination. Ask the patient to produce a few simple sounds and words, such as “ba,” “sh,” and “cat.” Compare muscle strength and tone in the limbs. Then evaluate tactile sensation. Ask the patient about numbness or tingling. Test deep tendon reflexes (DTRs), and note gait ataxia. Assess cerebellar function by observing rapid alternating movement, which should be smooth and coordinated. Next, test visual fields and ask about double vision. Check for signs of facial weakness, such as ptosis. Finally, determine level of consciousness (LOC) and mental status.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dysarthria:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If dysarthria isn't accompanied by respiratory muscle weakness and dysphagia, assess for other neurologic deficits. Compare muscle strength and tone in the limbs. Then evaluate tactile sensation. Ask the patient about numbness or tingling. Test deep tendon reflexes (DTRs), and note gait ataxia. Assess cerebellar function by observing rapid alternating movement, which should be smooth and coordinated. Next, test visual fields and ask about double vision. Check for signs of facial weakness such as ptosis. Next, determine the patient's level of consciousness (LOC) and mental status.
Obtain a patient history. Explore dysarthria completely. When did it begin? Has it gotten better? Speech improves with resolution of a transient ischemic attack, but not in a completed stroke. Ask if dysarthria worsens during the day. Then obtain a drug and alcohol history. Also ask about a history of seizures. Check dentures for a proper fit.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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