Clinical Presentation of Stroke

General The patient may not be able to reliably report the history owing to cognitive or language deficits. A reliable 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.

 Signs Patients usually have multiple signs of neurologic dysfunction, and the specific are determined by the 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.

Laboratory Tests
Tests for hypercoaguable states protein ! deficiency, antiphospholipid antibody" should be done only when the cause of 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 screen are 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".

Diagnostic Tests
Blood tests and brain imaging After doing a physical e)am and reviewing the patient*s
history, 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 in-ected to highlight any areas of blockage

 Heart testing An electrocardiogram .!/" is performed in most people who are thought to be having a stroke. 0ecause many people with 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 an echocardiogram. 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