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Clinical Presentation of

Stroke

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General

The patient may not be able to reliably report the

history owing to cognitive or language deficits. Areliable history may have to come from a family

member or another witness.

Symptoms The patient may complain of weakness on one

side of the body, inability to speak, loss of vision,

vertigo, or falling. Ischemic stroke is not usually painful but

patients may complain of headache, and with

hemorrhagic stroke, it can be very severe.

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Signs

Patients usually have multiple signs of neurologic

dysfunction, and the specific are determined bythe area of the brain involved.

Hemi- or monoparesis occurs commonly, as does

a hemisensory deficit.

Patients with vertigo and double vision are likely to

have posterior circulation involvement.

Aphasia is seen commonly in patients with anterior

circulation strokes.

Patients may also suffer from dysarthia, visual field

defects, and altered levels of consciousness.

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Laboratory Tests

Tests for hypercoaguable states protein ! deficiency,

antiphospholipid antibody" should be done only when the causeof the stroke cannot be determined based on the presence of

well-known risk factors for stroke.

Antiphospholipid antibodies as measure by anti cardiolipin

antibodies, B2 #glycoprotein I, and lupus anticoagulant screenare of higher yield than protein !, protein $, and antithrombin III

but should be reserved for patients who are young % &' years

of age", have had multiple venous(arterial thrombotic events, or

have livedo reticularis a skin rash".

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Diagnostic Tests

Blood tests and brain imaging

After doing a physical e)am and reviewing the patient*shistory, the doctor or nurse usually orders blood tests and

an imaging test eg, !T scan or +I" of the brain and the

surrounding blood vessels in the neck and head that supply

the brain with blood. T

he imaging allows the doctor or nurse to see the area of the

brain affected by the stroke, as well as to confirm the type

of stroke ischemic or hemorrhagic". a blood vessel in the

groin and threaded up to the blood vessels of the neck,

where dye is inected to highlight any areas of blockage

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Heart testing

An electrocardiogram !/" is performed in most people

who are thought to be having a stroke. 0ecause many peoplewith ischemic strokes also have coronary artery disease,

there may be a lack of blood flow called 1ischemia1" in the

heart during the stroke. In some cases, the person may not

be able to tell the clinician that he or she feels chest pain.

The !/ will help the clinician to diagnose and treat any

heart problems as 2uickly as possible.

3ther heart testing may also be recommended, such as anechocardiogram. This test uses sound waves to e)amine the

heart and the aorta the main artery that supplies the whole

body". In some people with embolic strokes, the heart or the

aorta is the source of the blood clot that led to the stroke