When a patient displays stroke-like symptoms, a doctor, often a neurologist (a doctor who specializes in managing strokes) must not only confirm the symptoms but also identify the type of stroke, its location, and the extent of brain damage. Treatment decisions hinge on all these issues. Testing is typically done quickly, since immediate treatment may limit brain and nerve damage.
The doctor first examines the patient and obtains a medical history, if possible. A standard exam includes checking blood vessels in the eyes, listening for unusual noises in the heart and in the prominent carotid arteries of the neck (a sign of atherosclerosis, or hardening of the arteries), measuring blood pressure and pulse rate, and testing strength, sensation, and reflexes (a sign of good nerve health).
CT or MRI scans are the most critical tests used to diagnose stroke.
Treatment is based on information gathered through a medical history, physical exam, and an emergency CT scan. Upon arrival in an emergency room with a suspected stroke, the doctors and medical staff will do the following tasks:
First, the hospital staff will assist a person with breathing, if the person is unconscious or losing consciousness, by providing supplemental oxygen.
A quick history will be taken from the patient or loved one to determine the exact time symptoms started.
A physical exam will be done to determine the severity of symptoms.
Next, an emergency CT scan will be obtained to determine the type of stroke and its size and location in the brain.
If the person is having an ischemic stroke, a clot buster drug (tPA) may be given via the veins (intravenously) to dissolve the obstructing clot. Clot busters need to be given within the first three to four and a half hours of the onset of symptoms. If it can't be determined when symptoms started, the patient is not a candidate for tPA. Clot busters are not given to people with hemorrhagic strokes as they may worsen the bleeding.
In a small number of cases, emergency surgery might be needed to drain blood from a hemorrhagic stroke or to clip a ruptured artery or aneurysm -- blocking off the vessel to halt further bleeding.