When assessing a patient with a possible stroke What should you check first?

An ambulance will take you straight to a hospital where you should be assessed as a priority. The doctors will do some tests to:

• make sure the symptoms are definitely due to stroke
• work out the type of stroke
• find out what area of the brain was affected
• work out how severe the impact of the stroke was on the brain
• if possible, find out and start treating the cause of the stroke.

Everyone will need a different set of tests. Common tests include:

Brain scans

Computerised tomography (CT scan) and magnetic resonance imaging (MRI) take pictures of your brain that show areas of damage and swelling. Either a CT scan or MRI should be done urgently within the first 24 hours after a stroke. This is to work out the type of stroke (ischaemic or haemorrhagic).

They may be repeated later to see how much of the brain has been affected by the stroke, or if you are getting worse.

Heart tests

An electrocardiogram (ECG) is a test for abnormal heart rhythm or heart disease. This test is recommended for all stroke patients.

An echocardiogram is an ultrasound to check for a clot or enlargement of a chamber in your heart.

Blood tests

There is no specific blood test for stroke. Blood tests are used to rule out other medical conditions and help the doctors decide the best treatment.

The most common blood tests will measure:

• the clotting ability of your blood (international normalised ratio or INR)
• fasting lipids (cholesterol) level
• renal (kidney) function
• glucose (blood sugar) levels
• electrolytes balance (salt levels)
• leukocyte (white blood cell) count
• haematocrit (iron) levels
• erythrocite sedimentation rate and c-reactive protein (as measures of inflammation in the body).

Other tests

In the early days in hospital, other tests that may be performed include:

• Transcranial Doppler (TCD) – an ultrasound that measures the speed of the blood flow in the brain arteries. This can help identify areas of slow blood flow in the brain.
• Cerebral angiogram – a catheter is placed in an artery and used to inject a special dye (contrast material). X-ray images are taken to see how the dye moves through the artery and blood vessels of the brain. This dye helps show any blockages in blood flow.
• Carotid duplex (also called a doppler) – an ultrasound that looks at neck arteries. It can tell if these arteries are narrow or partially blocked.
• Urine tests or chest X-rays may also be done to check for infection or other disease.

Regular observations will also be taken to monitor blood pressure, pulse (heart rate), temperature, blood sugar levels, oxygen levels and breathing pattern.

It is important that you ask questions during early testing after stroke, to help you understand the tests you have and the results. For example:

What        What is the test for and why is it being done?
Who         Who will be doing it?
When       When will I find out how it went?
Explain    Who will explain the results to me and/or my family?

Depending on the test results, you may be given emergency treatment for the stroke.

How do you know if someone is having a stroke? Think… F.A.S.T.

The Stroke Foundation recommends the F.A.S.T. test as an easy way to remember the most common signs of stroke. Using the F.A.S.T. test involves asking these simple questions:

• Face Check their face. Has their mouth drooped?
• Arms Can they lift both arms?
• Speech Is their speech slurred? Do they understand you?
• Time Is critical. If you see any of these signs call 000 straight away.

Order F.A.S.T. resources

Download F.A.S.T. Poster

Think F.A.S.T., act FAST

A stroke is always a medical emergency. The longer a stroke remains untreated, the greater the chance of stroke-related brain damage.

Other signs of stroke

Facial weakness, arm weakness and difficulty with speech are the most common symptoms or signs of stroke, but they are not the only signs. 

The following signs of stroke may occur alone or in combination:

• Weakness or numbness or paralysis of the face, arm or leg on either or both sides of the body
• Difficulty speaking or understanding
• Dizziness, loss of balance or an unexplained fall
• Loss of vision, sudden blurring or decreased vision in one or both eyes
• Headache, usually severe and abrupt onset or unexplained change in the pattern of headaches
• Difficulty swallowing

Sometimes the signs disappear within a short time, such as a few minutes. When this happens, it may be a transient ischaemic attack (TIA). After a TIA, your risk of stroke is higher. Stroke can lead to death or disability. A TIA is a warning that you may have a stroke and an opportunity to prevent this from happening.

If you or someone else experiences the signs of stroke, no matter how long they last, call 000 immediately.

What to do while you wait for an ambulance

Emergency medical treatment soon after symptoms begin improves the chance of survival and successful rehabilitation.