What tests might a doctor order for stroke?

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Doctors perform a physical exam to evaluate the symptoms a person presents with and give them a score.

The National Institutes of Health Stroke Scale (NIHSS) gauges the presence and severity of a stroke according to the final score.

The NIHSS uses the following parameters to determine this score:

• the ability to answer questions about location and time
• eye movement and visual acuity, which tests how the eye differentiates shapes and details of objects
• facial movement or paralysis
• the ability to move legs and arms
• sensation to touch
• the ability to perform physical instructions
• level of consciousness
• the ability to understand written and verbal communication
• the ability to speak and clarity

Read about what to expect with physical exams.

Doctors may order blood and heart tests for a person they suspect is having a stroke.

These tests may not indicate the location or presence of a stroke. However, they can provide important information about potential triggers, such as a blood clotting complication.

Some tests doctors may order include:

• a complete blood count to look at the different markers in the blood
• tests that assess for electrolyte issues
• tests that assess for clotting issues
• tests that assess muscle damage to the heart
• an EKG to measure the electrical activity of the heart muscle and help diagnose atrial fibrillation or a previous heart attack

Doctors may use a combination of imaging tests in their diagnostic workup.

These tests include:

• CT scan: A CT scan of the brain — also known as cranial CT scan — can determine if there is any bleeding or damage in the brain.
• MRI: This test can show if there are any tissue changes in the brain.
• Other imaging tests: This may include a PET or a subtraction angiography to check for any narrowing of blood vessels in the neck, aneurysms, or any other atypical formations in the brain that may have led to the stroke. Specialized tests such as CT angiography and CT perfusion may also be useful.

These tests produce images of the tissues and blood vessels in the brain, making it easier to spot bleeding, clots, or other potential issues that may have led to stroke. Imaging can also help determine the type of stroke that has occurred, including its location and extent.

Read about different stroke types.

A lumbar puncture — also known as a spinal tap — may help when a doctor suspects a person is experiencing subarachnoid hemorrhage, a type of hemorrhagic stroke.

To perform a lumbar puncture, a healthcare professional will collect fluid from a person’s spine using a needle. They will then test the fluid, looking for substances relating to damaged blood cells.

After diagnosing the type, extent, and location of the stroke, doctors will use this information to devise a short-term or long-term treatment plan. If they strongly suspect the person is currently having a stroke, they will prioritize treatment over testing.

Timing is crucial as the brain can develop permanent damage, which may lead to disability when there is a disruption or blockage of blood flow in the body, even for just a few minutes. If a person feels like they are experiencing stroke symptoms, they need immediate medical attention.

Contrastingly, from other cells in the human body, once the tissues and cells in the brain die due to the lack of oxygen, it is not possible to repair or restore them, leading to permanent damage. The primary aim of the treatment is to restore the blood flow to the brain as soon as possible to minimize and reduce the risk of further brain damage.

Doctors can use a combination of surgery and medications to treat a stroke, depending on its type.

Generally, treating ischemic strokes involves administering a tissue plasminogen activator (tpA). This helps break up blood clots that may be affecting blood flow to the brain. The sooner treatment starts, the better.

If a person cannot have tpA anti-platelet or blood-thinning medications, such as aspirin or clopidogrel (Plavix), may be necessary.

Doctors may recommend anticoagulant drugs, such as warfarin (Coumadin), to people to prevent future strokes.

If a person experiences a hemorrhagic stroke, treatment typically focuses on:

• stopping the bleeding
• reducing the pressure inside the skull
• preventing and managing high blood pressure and seizures

Doctors can typically achieve these goals by prescribing medications, such as saline solutions and mannitol (Osmitrol), or performing surgery.

A person may also receive additional care, such as:

• fluids
• breathing support
• compression therapy
• insertion of a feeding tube as it may be difficult for a person to swallow
• skin care to prevent skin irritation and the development of sores
• rehabilitation plans to relearn how to swallow, speak, and walk if a stroke has affected any of these

A stroke occurs when an area of the brain stops receiving oxygen. This is usually due to an interruption of the blood flow to the brain that causes hemorrhage or a blockage in the blood vessels. A stroke can cause permanent damage to the brain within a few minutes.

Treatment for a stroke should occur as soon as possible. To get more information, doctors use a combination of imaging tests and physical examination to quickly assess if a person is having a stroke as well as its extent and type. These tests can help guide the most appropriate treatment for the stroke and improve its outlook.