Diagnosing a Stroke and Common Stroke Terminology

Due to a stroke's damage, it is important to diagnose one as soon as possible. To do that follow the warning signs or use the algorithm B.E.F.A.S.T. (Balance, Eyes, Face, Arm, Speech, Time). Many progressive tests can be performed to assess whether a person has had a stroke, from a simple physical exam to a carotid doppler to see how blood flows through the carotid artery in the neck. To understand a stroke's results fully you have to know the stroke terminology.

Diagnosing a stroke

According to Mayo Clinic, various tests might be given to try to figure out what kind of stroke you are having and whether the symptoms are possibly due to something else like a drug reaction or brain tumor.

A physical exam is used to check for symptoms of a stroke. A medical and family history of illnesses will be performed, and you will be asked to provide a list of medications. Vital signs will be assessed. The doctor will check muscles, nerves, sensation, coordination, reflexes, memory, speech, and thinking because all can change with a stroke.

Bloodwork is completed to check how fast your blood clots, whether your blood sugar is too low or too high, and whether you have any anemia, clotting problems, an infection, or other blood problem. High blood sugar in a stroke is associated with larger lesions and worse functional outcomes. Blood tests will be done to provide more information and rule out other possible reasons for the stroke.

A computerized tomography (CT) scan might be performed. A detailed picture of the brain can be achieved by using a series of x-rays. A CT scan can show various problems, including bleeding in the brain, a tumor, an ischemic stroke, or other medical issues. Doctors will inject a dye into your bloodstream to view the blood vessels in your brain and neck. A doctor can usually diagnose a stroke by observing a person's symptoms. An MRI (magnetic resonance imaging) or a CT scan can assist in identifying the severity and type of stroke.

Magnetic resonance imaging (MRI) will provide a detailed view of brain damage using powerful radio waves and magnets. It can determine whether an ischemic stroke or brain hemorrhage did the damage. A magnetic resonance angiography or magnetic resonance venography may be performed by injecting dye into your blood vessel to see the arteries and veins and view the blood flow (magnetic). The best test is the brain MRI.

To determine if a blockage caused the stroke in the artery or by bleeding, most hospitals will give you a CT or MRI.

Since fatty deposits known as plaques can build up in the carotid arteries in your neck and obstruct blood flow, a carotid ultrasound may be performed. In this test, sound waves create detailed pictures of the internal aspect of these arteries.

An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. It uses sound waves to create detailed pictures of your heart.

In a critical situation like a stroke, it's important for doctors first to confirm the type of stroke to provide proper treatment. Imaging tests like a CT scan or MRI can help determine the type of stroke; blood flow tests like cerebral angiography can help evaluate the size and location of blockages.

To see how blood flows through the carotid artery in the neck, your doctor may also order a carotid ultrasound/Doppler scan and magnetic resonance angiogram (MRA), CT angiogram, or carotid angiogram.

Sometimes a stroke can be related to a heart problem, so your doctor may also request an echocardiogram to find out.

Your physician may check to see if you have coronary or peripheral artery disease, especially if the stroke is caused by the blockage or narrowing of the arteries to the brain. If plaque has narrowed or blocked one part of the body, it is also likely building up in other parts of the body, putting you at risk for other problems, such as a heart attack.

Terminology pertinent to strokes and stroke care

Agnosia – ability to see sense objects or people but have trouble recognizing them, can be visual, tactile, auditory, or related to one’s own body; senses are normal, and no memory loss is present.

Aphasia – Loss of ability to understand (receptive aphasia) or express speech (expressive aphasia), both difficulties (global aphasia).

Apraxia/ dyspraxia – difficulty with skilled movements and actions even if the person has the desire, ability to do them, and recognizes the objects. Reduced ability to coordinate, perform, plan, or carry out specific movements even when there is no paralysis. Inability to button up a shirt or tie shoelaces despite the physical ability to do so, may comb hair with a toothbrush or put a shirt on in the wrong order.

Central pain syndrome is damage to the central nervous system that can cause aching, burning, sharp pains, or numbness. Sometimes just a light touch may cause extreme, unrelenting pain.

Dysphagia – difficulty swallowing in the mouth of the tube that runs down the back of the nose into the neck (results in coughing, loss of food from the mouth, feeling food is “stuck” in the throat, gurgling sounds, etc.).

Dysarthria – weakness, and loss of control of the facial, tongue, and mouth muscles. People with dysarthria may know exactly what they want to say. Slow, slurred, muffled, hoarse, or nasal speech.

Hemiparesis – weakness or mild loss of strength on one side of the body, the leg, arm, or face.

Hemiplegia – paralysis, severe or complete loss of strength on one side of the body.

Hemianopia – blindness over half the field of vision in each eye. Both eyes are affected. When reading, words and sentences disappear when in the missing visual field. People may appear to have only half a face. When drawing a clock, they may put all the numbers on the right side.

Neglect – lack of attention paid to things on one side of the body, inability to perceive, report, and orient to sensory events towards one side of space. Also known as spatial neglect. Not an eyesight or memory problem. Neglect can be someone who does not recognize his arm or leg, ignore food on one side of the plate or objects on one side of the room. After a right-sided stroke, a woman may not put makeup on the left side of her face. Neglect often occurs in right-hemisphere strokes, causing inattention to the left side.

Pseudobulbar affect (PBA) – PBA is characterized by a mismatch between feelings and expression, like laughing at a funeral or crying at a joke. PBA is more common in individuals who have had a brainstem stroke, but it can also occur with other types of strokes.

Spasticity – spasticity occurs when a muscle involuntarily contracts when you move. It can be painful – like a charley horse – and create stiffness and tightness. When a muscle can't complete its full range of motion, the surrounding tendons and soft tissue can become tight. This makes stretching the muscle much more difficult. If not untreated, the muscle can freeze permanently into an abnormal, often painful position. Spasticity in the arm can cause a fisted hand position, bent elbow, and arm curled tightly against the chest. Spasticity in the leg may cause a stiff knee, pointed foot, and curling toes. This can seriously interfere with the ability to perform daily activities.

Visual-spatial loss – do not know where objects are located, including their own body, may overreach for an object to the space they are in, resulting in difficulty overreaching for objects – may knock over a nearby object, may also have difficulty discerning an object from its’ background (figure-ground) like milk in a coffee cup.

There are many tests to diagnose a stroke, some more complex than others. Learning the key stroke terminology will help you better understand a stroke's results and how it can affect a person’s functioning.

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