Diagnosis

Stroke consultation Stroke consultation

Stroke consultation at Mayo Clinic

If you're experiencing stroke symptoms, getting to a highly specialized treatment center that can quickly diagnose and deliver individualized treatment can have a dramatic impact on your outcome.

At Mayo Clinic, the nation's leading neurosciences team of emergency stroke experts will quickly evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your care team will likely use several tests to immediately determine your risk of stroke, including:

  • Examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present.

    Your doctor will want to know what medications you take and whether you have experienced any head injuries. You or your family member may be asked about your personal and family history of heart disease, transient ischemic attack or stroke.

    Your doctor will perform a detailed neurological and medical examination. This includes checking your blood pressure and using a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck, which may indicate hardening or narrowing (atherosclerosis) of the carotid arteries. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.

  • Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Care providers will manage your blood's clotting time and levels of sugar and key chemicals as part of your stroke care.
  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding (hemorrhage), tumors, strokes and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
  • Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).
  • Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. For this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. 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.

    You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.

    Mayo Clinic subspecialized experts conduct these tests and immediately collaborate with each other to provide accurate diagnoses and timely treatment strategies individualized for each patient.

Nov. 22, 2014
References
  1. Stroke: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/stroke.htm. Accessed Nov. 9, 2013.
  2. Oliveira-Filho J. Initial assessment and management of acute stroke. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  3. Know stroke brochure. National Institute of Neurological Disorders and Stroke. http://stroke.nih.gov/materials/actintime.htm. Accessed Nov. 9, 2013.
  4. Go AS, et al. Heart disease and stroke statistics — 2013 update: A report from the American Heart Association. Circulation. 2013;127:e6.
  5. Warning signs of a stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed Nov. 9, 2013.
  6. Caplan LR. Overview of the evaluation of stroke. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  7. Caplan LR. Etiology and classification of stroke. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  8. Ischemic stroke (clots). American Stroke Association. http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp. Accessed Nov. 9, 2013.
  9. Cerebral aneurysms fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_aneurysm/cerebral_aneurysms.htm. Accessed Nov. 9, 2013.
  10. Furie KL, et al. Etiology and clinical manifestations of transient ischemic attack. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  11. Effects of stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=EFFECT. Accessed Nov. 9, 2013.
  12. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm?css=print. Accessed Nov. 9, 2013.
  13. What is echocardiography? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/echo/. Accessed Nov. 9, 2013.
  14. Samuels OB. Intravenous fibrinolytic (thrombolytic) therapy in acute ischemic stroke: Therapeutic use. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  15. Oliveira-Filho J, et al. Reperfusion therapy for acute ischemic stroke. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  16. Cucchiara BL, et al. Antiplatelet therapy for secondary prevention of stroke. http://www.uptodate.com/home. Accessed Nov. 9, 2013.
  17. Questions and answers about carotid endarterectomy. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/carotid_endarterectomy_backgrounder.htm. Accessed Nov. 10, 2013.
  18. Mohler ER, et al. Carotid endarterectomy. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  19. Greelish JP, et al. Carotid artery stenting and its complications. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  20. Rordorf G, et al. Spontaneous intracerebral hemorrhage: Prognosis and treatment. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  21. Arteriovenous malformations and other vascular lesions of the central nervous system fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/avms/avms.htm. Accessed Nov. 9, 2013.
  22. Recovery and rehabilitation. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=REHABT. Accessed Nov. 9, 2013.
  23. Recovery after stroke — Coping with emotions. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed Nov. 9, 2013.
  24. Recovery after stroke — Social support. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed Nov. 9, 2013.
  25. Recovery after stroke — Thinking and cognition. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed Nov. 9, 2013.
  26. Controllable risk factors — High blood pressure (hypertension). National Stroke Association. http://www.stroke.org/site/PageServer?pagename=HighBloodPressure. Accessed Nov. 9, 2013.
  27. STARS — Steps against recurrent stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=STARS. Accessed Nov. 9, 2013.
  28. Physical activity and healthy diet. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=eathealthy. Accessed Nov. 9, 2013.
  29. Furie KL, et al. Secondary prevention of stroke: Risk factor reduction. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  30. Oliveira-Filho J, et al. Antithrombotic treatment of acute ischemic stroke. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  31. Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 11, 2013.
  32. Singer RJ, et al. Treatment of aneurysmal subarachnoid hemorrhage. http://www.uptodate.com/home. Accessed Nov. 10, 2012.
  33. Quality check. The Joint Commission. http://www.qualitycheck.org/consumer/searchresults.aspx?nm=Mayo+Clinic&ddstatelist=&st_nm=-1&st=. Accessed Nov. 10, 2013.
  34. U.S. News best hospitals 2012-2013. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/neurology-and-neurosurgery. Accessed Nov. 9, 2013.
  35. U.S. News best hospitals 2012-2013. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/rehabilitation. Accessed Nov. 9, 2013.
  36. Anderson CS, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. New England Journal of Medicine. 2013;368:2355.
  37. Life after stroke. National Stroke Association. http://strokeassociation.org/STROKEORG/LifeAfterStroke/RegainingIndependence/PhysicalChallenges/Post-Stroke-Rehabilitation_UCM_310447_Article.jsp. Accessed Nov. 10, 2013.
  38. Post-stroke rehabilitation fact sheet. National Institute of Neurological Disorders and Stroke. http://stroke.nih.gov/materials/rehabilitation.htm. Accessed Nov. 10, 2013.
  39. Broderick JP, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. New England Journal of Medicine. 2013;368:893.
  40. Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed Nov. 9, 2013.
  41. Brott TG, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine. 2010;363:11.
  42. Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Nov. 10, 2013.
  43. Rordorf G, et al. Spontaneous intracerebral hemorrhage: Pathogenesis, clinical features and diagnosis. http://www.uptodate.com/home. Accessed Nov. 10, 2013.
  44. Jauch EC, et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870.
  45. Estruch R, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine. 2013;368:1279.
  46. Ovbiagele B, et al. Level of systolic blood pressure within the normal range and risk of recurrent stroke. JAMA. 2011;306:2137.
  47. Flemming KD, et al. Utility of a post-hospitalization stroke prevention program managed by nurses. Hospital Practice. 2013;41:70.
  48. Saver JL, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309:2480.
  49. Ciccone A, et al. Endovascular treatment for acute ischemic stroke. New England Journal of Medicine. 2013;368:904.
  50. Xian Y, et al. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA. 2012;307:2600.
  51. Singh B, et al. Endovascular therapy for acute ischemic stroke: A systematic review and meta-analysis. Mayo Clinic Proceedings. 2013;88:1056.
  52. Controllable risk factors — Alcohol use. National Stroke Association.  http://www.stroke.org/site/PageServer?pagename=alcohol. Assessed Sept. 24, 2014.
  53. Stroke treatments. American Stroke Association. Accessed Oct. 6, 2014. http://www.strokeassociation.org/STROKEORG/AboutStroke/Treatment/Stroke-Treatments_UCM_310892_Article.jsp

You Are ... The Campaign for Mayo Clinic

Mayo Clinic is a not-for-profit organization. Make a difference today.