History profiling the timing of neurological events

from the patient or family member.

first ask the patient or a companion what happened

and when the possible stroke symptoms began.

Of particular importance are the pattern of onset

and course of initial neurological symptoms.

 Episodes of transient ischemic attack (TIA or "mini

stroke") Head trauma Presence of major and minor risk factors High blood pressure (hypertension) Diabetes. Carotid artery stenosis Cardiac conditions

 Includes general medical examination as well as

neurological examination.
Investigation of vital signs and signs of cardiac

decompression is essential.
neurological examination stresses functions of

cerebral hemisphere, cerebellum, cranial nerves, eyes and sensorimotor system.

 Presenting symptoms will help to determine the

location of the lesion, and comparison of both sides of the body reveal side of the lesion.
Bilateral signs are suggestive of brain stem lesion or

massive cerebral involvement.

 Neck flexion

Meningeal irritation secondary to subarachnoid

hemorrhage produce resistance and pain with neck flexion. Palpation of arteries Both superficial and deep arteries are palpated including temporal, facial, carotid, subclavian, brachial, radial, abdominal, aorta and lower extremity arteries.

 Auscultation of heart and blood vessels

Abnormal heart sounds, murmur, or bruits may be

present and indicate increased flow turbulence and stenosis in vessel.

Ophthalmic pressure abnormal pressure in the ophthalmic artery indicates

problem in the internal carotid artery.

1)

2)
3) 4)

5)
6) 7)

8)
9)

Urinalysis Blood analysis Fasting blood glucose level Blood chemistry profile Blood cholesterol and lipid profile Thyroid function test Full cardiac evaluation Echocardiography Lumbar puncture

 CT

MRI
PET (position emission tomography) Transcranial and carotid Doppler

Cerebral angiography

 The first priority will be to determine ischemic or

hemorrhagic stroke. This distinction is critical because the medicine given for an ischemic stroke (caused by a blood clot) could be life-threatening if the stroke is hemorrhagic (caused by bleeding).

 The first test after a stroke is typically a computed

tomography (CT) scan of the brain which is a series of X-rays of your brain that can show whether there is bleeding. This test will help your doctor diagnose whether the stroke is ischemic or hemorrhagic. Magnetic resonance imaging (MRI) may also be done to find out the amount of damage to the brain and help predict recovery.