After a stroke it is essential to determine the type of cerebrovascular accident and the area of the brain affected to identify the type of treatment needed. Several tests may be needed.
Starting with a physical examination, the doctor will need to know the symptoms experienced, when they started and what you were doing at the time. Also he will need to know of you are taking any medications. And about your medical history and also your family’s in relation to history of heart disease, transient ischaemic attack and stroke.
The blood pressure will be taken and a stethoscope will be used to listen to your heart and also to check for a rushing sound (murmur) in the arteries in the neck (carotids), which can indicate atherosclerosis. An ophthalmoscope may also be used to check for signs of small cholesterol crystals or clots in the retinal blood vessels.
Multiple blood tests will be carried out to identify the status of blood coagulation, whether blood sugar is abnormally high or low, whether critical chemical substances in the blood are imbalanced or whether you might have an infection. Managing coagulation time, sugar levels and other key chemical substances will form part of your care following a stroke.
Subsequently a computerised tomography scan investigation can show a haemorrhage, tumour, stroke and other conditions. A substance will be injected into the blood stream to see blood vessels in the neck and brain in greater detail Different types of computerised tomography according to your condition.
Also Magnetic resonance using powerful radio waves and magnets would be used to create a detailed view of the brain. This can detect damaged brain tissue due to an ischaemic stroke, and cerebral haemorrhage. An injected substance into a blood vessel will show the arteries and veins and highlight the blood flow (magnetic resonance arterial or venous angiography).
With a Carotid ultrasound waves it is possible to create detailed images of the inside of the carotid arteries in the neck. This test shows the accumulation of fat deposits (plaques) and the blood flow in the carotid arteries.
With a Cerebral Angiography test a thin, flexible tube (catheter) is inserted through a small incision, usually in the groin, and guided through the main arteries into the carotid or vertebral artery. Then a substance is injected into the blood vessels so that they can be seen using X-ray imaging. This procedure provides a detailed view of the cerebral arteries and the arteries in the neck.
The Echocardiogram uses sound waves to create detailed images of the heart. An echocardiogram can find the origin of clots in the heart, clots which may have been displaced from there towards the brain causing the stroke.
With a transoesophageal echocardiogram a flexible tube is inserted through the throat with a small device (transducer) attached, passing it down to the tube that connects the back of the mouth with the stomach (oesophagus). As the stomach is directly behind the heart, a transoesophageal echocardiogram can create clear and detailed ultrasound images of the heart and of any blood clot.
At HC Marbella our highly experienced specialists, Dr. Jesús Romero Imbroda, use the most advanced equipment available to determine the status, or risk, of a stroke.