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Early testing after stroke

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.