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16 Equipment and Procedures What tests are available to diagnose a stroke? One or more of the following tests may be required to accurately diagnose a stroke: Computed tomography angiogram (CTA): This test is done in the CT scanner. Intravenous contrast material (dye) is given and pictures are taken of the major blood vessels in and around the brain. This test is used to detect large blood vessels that may be blocked. It takes 15-20 minutes to perform and does not hurt. Magnetic resonance imaging (MRl)/Magnetic resonance angiography (MRA): This test uses the body 's own magnetic properties to look at the brain tissue and the blood vessels. In some cases, an MRI can also be used to evaluate how much damage has already occurred to the brain tissue and brain function. This test takes 20-30 minutes to perform and does not hurt. Cerebral angiogram: With this test, a thin plastic tube (called a catheter) is inserted into an artery in the leg or arm through a small incision in the skin. Using X-ray guidance, the catheter is guided up the artery through the neck artery to the brain or area being examined. Once there, contrast material (dye) is injected through the tube, into the blood and images are captured using X-rays. This lets a doctor see all the brain's large and small blood vessels. It is the most accurate test for directly looking at all of the brain's blood vessels to detect any blockages that may have caused a stroke. It is also used to determine if an aneurysm is present or if a blood vessel is abnormal. Although slightly more invasive, it is often required to accurately assess whether there is an abnormality. Carotid ultrasound or "doppler" scan: This test involves placing a small probe (called a transducer) over the neck. Ultrasound waves are then used to look at the blood flow in the neck. It does not hurt, and it allows rapid evaluation of the relative amount of blood flowing to the brain. Echocardiogram: This test uses high frequency sound waves (ultrasound) to take pictures of the heart's chambers, valves, walls and the blood vessels attached to the heart. A probe (called a transducer) is passed over the chest. The probe produces sound waves that bounce off the heart and "echo" back to the probe. The waves are changed into pictures viewed on a video monitor. This will allow the doctor to see the heart's structure, look for any abnormalities that may contribute to stroke and check how well the heart is functioning. This test does not hurt. Electrocardiogram (EKG/ECG): This test records the electrical activity of the heart, including the timing and duration of each heartbeat. Electrodes are placed on the skin of the limbs and surface of the chest and the electrical activity of the heart is recorded over a period of time. This test is used to monitor the heart's function and detect any abnormal changes in heart rhythm. This test does not hurt.

• Your Guide to Acute Stroke
• Welcome to Providence St. Jude Medical Center
• How to Use This Guide
• Table of Contents
• Stroke Symptoms
• Spot a Stroke
• Risk Factors for Stroke
• Factors you cannot control:
• Factors you can control (we'll look at each one in more depth below):
• Risk Factors You Can Control
• High blood pressure, cont.
• Carotid artery disease
• Atrial fibrillation (AFib)
• Patent foramen ovale (PFO)
• Sickle cell disease
• Physical inactivity Include exercise in your daily routine.
• Even a little bit of exercise — such as a brisk walk, bicycle ride, swim or yard work — can improve your health and may reduce your stroke risk.
• Adults should perform moderate physical activities for at least 30 minutes for five or more days a week, according to the Centers for Disease Control and Prevention.
• Try exercising with a friend; this may make it more likely that you'll make it a habit.
• Before starting a vigorous exercise program, check with your doctor.
• Weight and diet Enjoy a lower sodium (salt), lower fat diet.
• By cutting down on salt and fat in your diet, you may lower your blood pressure and, more importantly, lower your risk for stroke.
• Try to eat a balanced diet each day, with plenty of fruits, vegetables, whole grains and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu and beans).
• Circulation problems Ask your doctor if you have circulation (blood flow) problems, which increase your stroke risk. If so, work with your doctor to control them.
• Circulation problems can usually be treated with medicine. If your doctor prescribes medicine, take it exactly as recommended.
• Occasionally, surgery is necessary to correct circulation problems such as a blocked artery.
• Blood Supply to the Brain
• Motor and Sensory Function
• Left and Right Brain Hemispheres
• Normal and Blocked Artery Blood Flow
• Transient Ischemic Attack
• Ischemic Stroke
• There are two types of ischemic strokes: embolic and thrombotic.
• Hemorrhagic Stroke
• There are two types of hemorrhagic strokes: intracerebral and subarachnoid.
• Aneurysm
• Equipment and Procedures
• National Institute of Health Stroke Scale (NIHSS): This tool is used by health care providers to objectively quantify the impairment caused by a stroke. The scale is composed of 11 items, each of which scores a specific ability between a zero and four. Fo
• Swallow evaluation: After a stroke, some patients experience difficulty with swallowing, placing them at risk for choking or aspiration of food or fluid into their lungs. This can lead to complications of a lung infection called pneumonia. For these reaso
• Medications
• What should I know about antiplatelet agents? Antiplatelet medicines keep blood clots from forming by preventing blood platelets from sticking together. They're used as part of a treatment for patients with atherosclerosis or with increased clotting tend
• Antiplatelets are generally prescribed preventively when atherosclerosis is evident but there is not yet a large obstruction in the artery.
• Antiplatelet drugs include aspirin, clopidogrel (Plavix®) and dipyridamole/aspirin (Aggrenox®).
• How does aspirin help? Aspirin is an important therapeutic agent for stroke prevention. It's a medicine that can save your life if you have heart problems, or if you have had a stroke or TIA. You must use aspirin just as your doctor tells you and not in
• Antihypertensive Medications Anticoagulants and antiplatelet agents are medicines that reduce blood clotting in an artery, a vein or the heart. Blood clots can block blood flow to the brain, causing a stroke. When doctors want to help prevent strokes caus
• What should I know about anticoagulants? High blood pressure is called hypertension; medications that lower high blood pressure are called antihypertensive medications. You may be prescribed one or more antihypertensive medications to help control your hi
• Diuretics:These medications work by flushing excess water and sodium out of your body, thereby lowering blood pressure. Some common examples are hydrochlorothiazide (Microzide®) and furosemide (Lasix®).
• Beta blockers: These medications work by blocking certain nerve and hormonal signals to the heart and blood vessels, thus lowering blood pressure. Frequently prescribed beta blockers include metoprolol (Lopressor®, Toprol XL®), atenolol (Tenormin®), carve
• Angiotensin-converting enzyme (ACE) inhibitors: These medications allow blood vessels to widen by preventing a hormone called angiotensin from affecting blood vessels. Some common examples of ACE Inhibitors are benazepril (Lotensin®), lisinopril (Prinivil
• Angiotensin II receptor blockers (ARBs): These help blood vessels relax by blocking the action of a hormone called angiotensin. Frequently prescribed ARBs include losartan (Cozaar®), olmesartan (Benicar®) and valsartan (Diovan®).
• Calcium channel blockers: These prevent calcium from going into heart and blood vessel muscle cells, thus causing the cells to relax, which lowers blood pressure. Frequently prescribed calcium channel blockers include amlopidine (Norvasc®), diltiazem (Car
• Miscellaneous antihypertensive medications:
• Clonidine (Catapres®): This medication lowers the body's release of adrenaline and other hormones that raise blood pressure, heart rate and anxiety.
• Hydralazine (Apresoline®): This medication calms the blood vessels, thus lowering blood pressure.
• Side effects of antihypertensive medications Each medication has its own specific set of side effects. Some of the more common side effects of antihypertensive medications are: becoming dizzy or lightheaded when standing or changing position suddenly, u
• When going home on new antihypertensive medications, it is a good idea to purchase a blood pressure machine to monitor your blood pressure. Blood pressure machines can be purchased at local pharmacies and online. Discuss with your doctor what your blood
• Cholesterol-lowering Medications Along with diet and lifestyle changes, high cholesterol levels in the blood can be lowered with medication. You may be prescribed one or more cholesterol-lowering medications to help lower your high cholesterol. There are
• Statins: Statins block the production of cholesterol in the liver. They lower LDL (the "bad" cholesterol) and triglycerides, and have a mild effect in raising HDL (the "good" cholesterol). Some commonly prescribed statins are simvastatin (Zocor®), atorvas
• Cholesterol absorption inhibitors: These medications lower the amount of cholesterol that your body absorbs. A common example is ezetimibe (Zetia®). This medication can be combined with statins and comes in a combination form known as Vytorin® (ezetimibe
• Fibrates: These reduce the production of triglycerides by the liver and can increase HDL (the "good" cholesterol). Some common examples are gemfibrozil (Lopid®) and fenofibrate (TriCor®).
• Bile acid binding resins: These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's su
• Side effects of cholesterol-lowering medications Each medication has its own specific set of side effects. Some of the more common side effects of cholesterol-lowering medications are: nausea, changes in bowel pattern (diarrhea or constipation), stomach
• Take all medications as instructed at discharge and follow up with your doctor.
• Glossary of Neurological Terms and Disorders
• Cerebral atrophy The shrinking of the brain or brain cells.
• Cerebrovascular accident (CVA) Stroke or brain attack.
• Coma State of unarousable unresponsiveness with closed eyes, no speech and no purposeful movements.
• Common carotid artery Artery that arises from the brachiocephalic artery on the right and from the aortic arch on the left, rising in the neck and dividing at the upper border of the thyroid cartilage into the external and internal carotid arteries to sup
• Craniectomy Surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues or relieving intracranial pressure, in which the bone flap is not replaced at the end of the procedure.
• Craniotomy Surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying issue, in which the bone flap is replaced at the end of the procedure.
• Dementia Acquired and sustained loss of memory and other intellectual functions that are severe enough to interfere with daily functioning.
• Diplopia Double vision.
• Dysarthria Inability to pronounce or articulate words caused by lack of muscle control resulting from damage to the central nervous system.
• Dysphagia Difficulty in swallowing.
• Hemianesthesia Loss of sensation on one half of the body.
• Hemianopia Loss of vision in one half of the visual field, indicating a pathological process posterior to the optic chiasm.
• Hemiparesis Weakness on one side of the body.
• Hemiplegia Paralysis on one side of the body.
• Infarction Permanent tissue damage and death of all cellular elements (neurons, glia, vessels) due to prolonged or severe ischemia.
• Ischemia Impairment of tissue function due to a reduction in blood supply relative to metabolic demand.
• Lacunae (lacunar stroke) Small (< 2 cm) infarct caused by a blockage of a single penetrating branch of a larger cerebral artery.
• Neglect Failure to acknowledge stimuli toward the side of space opposite to a hemispheric (usually parietal) lesion.
• Non-fluent aphasia (Broca's or expressive aphasia) Selective impairment of language production including impaired repetition due to a lesion of the left inferior frontal lobe.
• Paresis Reduced ability to activate motor neurons, weakness.
• Transient ischemic attack (TIA) Abrupt focal loss of neurologic function caused by reduction in blood flow that persists less than 24 hours and clears without residual disability.
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