Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan.
When you first arrive at hospital with a suspected stroke, the doctor will want to find out as much as they can about your symptoms.
A number of tests can be carried out to help confirm the diagnosis and determine the cause of the stroke.
This may include:
- blood tests to determine your cholesterol and blood sugar levels
- checking your pulse for an irregular heartbeat
- taking a blood pressure measurement
Even if the physical symptoms of a stroke are obvious, brain scans should also be carried out to determine:
- if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
- which part of the brain has been affected
- how severe the stroke is
Everyone with suspected stroke should receive a brain scan within an hour of arriving at hospital.
An early brain scan is especially important in those who:
- might benefit from clot-busting drugs (thrombolysis) such as alteplase or early anticoagulant treatment
- are already on anticoagulant treatments
- have a lower level of consciousness
This is why a stroke is a medical emergency and 999 should be dialled when a stroke is suspected – there isn't time to wait for a GP appointment.
The two main types of scan used to assess the brain in people who have had a suspected stroke are:
A CT scan is like an X-ray, but uses multiple images to build up a more detailed, three-dimensional picture of your brain to help your doctor identify any problem areas.
During the scan, you may be given an injection of a special dye into one of the veins in your arm to help improve the clarity of the CT image and look at the blood vessels that supply the brain.
If it's suspected you're experiencing a major stroke, a CT scan is usually able to show whether you've had an ischaemic stroke or a haemorrhagic stroke. It's generally quicker than an MRI scan and can mean you're able to receive appropriate treatment sooner.
An MRI scan uses a strong magnetic field and radio waves to produce a detailed picture of the inside of your body.
It's usually used in people with more complex symptoms, where the extent or location of the damage is unknown. It's also used in people who have recovered from a transient ischaemic attack (TIA).
This type of scan provides greater detail of brain tissue, allowing smaller, or more unusually located areas, affected by a stroke to be identified.
As with a CT scan, special dye can be used to improve MRI scan images.
A swallow test is essential for anybody who has had a stroke, as swallowing ability is commonly affected early after having a stroke.
When a person can't swallow properly, there's a risk that food and drink may get into the windpipe and lungs, which can lead to chest infections such as pneumonia. This is called aspiration.
The test is simple. The person is given a few teaspoons of water to drink. If they can swallow this without choking and coughing, they'll be asked to swallow half a glass of water.
If they have any difficulty swallowing, they'll be referred to the speech and language therapist for a more detailed assessment.
They usually won't be allowed to eat or drink normally until they've seen the therapist. Fluids or food may need to be given directly into a vein in the arm (intravenously) or through a tube inserted into their stomach via their nose.
Heart and blood vessel tests
Further tests on the heart and blood vessels might be carried out later to confirm what caused your stroke. Some of the tests that may be carried out are described below.
A carotid ultrasound scan can help show if there's any narrowing or blockages in the neck arteries leading to your brain.
An ultrasound scan involves using a small probe (transducer) to send high-frequency sound waves into your body. When these sound waves bounce back, they can be used to create an image of the inside of your body.
When carotid ultrasonography is needed, it should happen within 48 hours.
An echocardiogram may be carried out to produce images of your heart and check for any problems that could be related to your stroke.
This normally involves moving an ultrasound probe across your chest (transthoracic echocardiogram).
An alternative type of echocardiogram called transoesophageal echocardiography (TOE) may sometimes be used.
An ultrasound probe is passed down your gullet (oesophagus), usually under sedation. As this allows the probe to be placed directly behind the heart, it produces a clear image of blood clots and other abnormalities that may not get picked up by a transthoracic echocardiogram.