Which diagnostic tests are priority for a patient who had a stroke and needs a cardiac assessment?

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Table of Contents Show

What are the types of stroke?
Who is at risk for a stroke?
What are the symptoms of stroke?
How are strokes diagnosed?
What are the treatments for stroke?
Can strokes be prevented?

Also called: Brain attack, CVA

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

What are the types of stroke?

There are two types of stroke:

Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but if you have had a TIA, you are at a much higher risk of having a stroke.

Who is at risk for a stroke?

Certain factors can raise your risk of a stroke. The major risk factors include:

High blood pressure. This is the primary risk factor for a stroke.
Diabetes.
Heart diseases. Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
A personal or family history of stroke or TIA.
Age. Your risk of stroke increases as you get older.
Race and ethnicity. African Americans have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

What are the symptoms of stroke?

The symptoms of stroke often happen quickly. They include:

Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
Sudden confusion, trouble speaking, or understanding speech
Sudden trouble seeing in one or both eyes
Sudden difficulty walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause

If you think that you or someone else is having a stroke, call 911 right away.

How are strokes diagnosed?

To make a diagnosis, your health care provider will:

Ask about your symptoms and medical history
Do a physical exam, including a check of
- Your mental alertness
- Your coordination and balance
- Any numbness or weakness in your face, arms, and legs
- Any trouble speaking and seeing clearly
Run some tests, which may include

What are the treatments for stroke?

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

Acute treatment, to try to stop a stroke while it is happening
Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
If an aneurysm if the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through
- Surgery
- Injecting a substance into the blood vessels of the AVM to block blood flow
- Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and to have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

Can strokes be prevented?

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

Craniotomy - slideshow (Medical Encyclopedia) Also in Spanish

Stroke Connection e-news (American Stroke Association)

Stroke: Unique to Older Adults (AGS Foundation for Health in Aging)

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

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A stroke happens when the flow of blood to part of your brain gets cut off. This means your brain can't get oxygen, and without that, brain cells can be damaged in minutes. That's why it's important to get to the emergency room right away if you think you're having a stroke. You might need a clot-busting drug within the first 3 hours.

Signs of a stroke can be different for different people. The F-A-S-T test is an easy way to remember them:

Face: Smile. Does one side of your face sag?
Arms: Raise both and see if one droops.
Speech: Say a common phrase: Does it sound strange or slurred?
Time: Call 9-1-1 right away if you notice any of these symptoms. Note what time they started.

At the hospital, your doctor will want to rule out other conditions that might cause your symptoms. These could include seizure, migraine, low blood sugar, or a heart problem.

Your doctor may:

Ask when your symptoms started and get information about your medical history
Check how alert you are, and see if you can't move one side of the face or you have trouble with coordination and balance
Check if you feel numb or weak in any part of your body
See if you have trouble with your vision or speech
Do a physical exam, take your blood pressure, and listen to your heart

Your doctor then will need to do blood tests and imaging tests to figure out which type of stroke you might have had. The most common kind is called ischemic stroke. Almost 90% of people who have a stroke have this, and it happens when a clot blocks blood flow. A hemorrhagic stroke is when you have bleeding in your brain.

Complete blood count. This includes a check for your level of platelets, which are cells that help clot blood. A lab will also measure electrolyte levels in your blood to see how well your kidneys are working.

Clotting time. A pair of tests called PT (prothrombin time) and PTT (partial thromboplastin time) can check how quickly your blood clots. If it takes too long, it could be a sign of bleeding problems.

Computerized tomography (CT). Your doctor takes several X-rays from different angles and puts them together to show if there's any bleeding in your brain or damage to brain cells. They may put dye in your vein first to look for an aneurysm, a thin or weak spot on an artery.

Magnetic resonance imaging (MRI). This uses powerful magnets and radio waves to make a detailed picture of your brain. It's sharper than a CT scan and can show injuries earlier than a traditional CT.

Carotid ultrasound. This uses sound waves to find fatty deposits that may have narrowed or blocked the arteries that carry blood to your brain.

Echocardiogram. Sometimes a clot forms in another part of the body (often the heart) and travels to the brain. This imaging test of the heart can look for clots in the heart or enlarged parts of the heart.

Angiograms of your head and neck. Your doctor will put dye in your blood so they can see your blood vessels with X-rays. This can help find a blockage or aneurysm.

Your doctor may put a clot-busting drug called tPA in your arm. You should get it within 3 hours of the stroke. In some situations, you can get it 4.5 hours later. You'll probably have it while you're still in the ER.

If you can't have tPA, which is a powerful drug and can cause bleeding, you might take aspirin or another medicine to thin your blood or keep clots from getting bigger.

Another option is to remove the clot after you arrive at the hospital. Your doctor will thread a device called a stent up the artery to grab the clot, or take it out with a suction tube. They also can use a tiny, flexible tube called a catheter to send drugs up to your brain and directly to the clot.

The first goal is to find and control the bleeding. If you take blood thinners, the doctor will take you off them. The next step depends on what caused your stroke.

The No. 1 reason for a hemorrhagic stroke is uncontrolled high blood pressure. If this led to yours, you'll probably need to take medicine to lower it.

If an aneurysm caused your stroke, your doctor may clamp the broken vessel closed or thread a tiny coil through it that helps to keep the blood vessel from bursting again.

You'll take medication to sleep through either procedure, and you'll recover in the hospital.

Tangled blood vessels also can cause a stroke. (Some people are born with these.) In that case, your doctor might take them out with surgery, use radiation to shrink them, or use a special substance to block the flow of blood to them.

Once they treat the cause of your stroke, your doctor will work with you to lower your chances of another one. For example, they may help you keep your blood pressure in a healthy range.