Physical Examination - Diagnosing A Stroke: Stroke

Content provided by the Faculty of the Harvard Medical School

Physical examination

The most important part of the process is assessing your neurological symptoms and signs (such as numbness or weakness on one side of your body) and the time frame in which they occurred. These are indispensable clues to the nature of the stroke and the type of vascular disease that caused it. The doctors — typically an emergency team and a neurologist — will take a careful medical history, asking about past events and any risk factors that suggest a stroke, such as a previous stroke or TIA, diabetes, hypertension, cardiovascular disease, or neurological disorders. If you aren't able to answer these questions, the doctor will ask one of your relatives or close friends.

During the examination, the doctor will measure your blood pressure in both arms and listen to your heartbeat to check for carotid bruits, the abnormal rushing sounds made by blood flowing through a narrowed vessel. Hearing a bruit is strong evidence that you have a narrowed carotid artery. The doctor will also do a neurological examination to assess your brain functions, such as memory, motor skills, hearing, vision, touch, and the ability to read, write, and speak. As part of this neurological exam, you may be asked to bare your gums and stick out your tongue. The doctor may also test your hearing by making slight sounds next to each ear, and check your eyesight by asking you to read something or track a moving object using one eye at a time.

With these techniques, the doctor can home in on the general area of the brain that has been affected. Speech or language difficulties generally indicate a stroke on the left side of the brain. Impaired function on one side of the body signals damage to the opposite side of the brain. Problems with movement and balance usually mean trouble with the cerebellum.

Your medical and neurological history, along with the results of the physical and neurologic exams, allow the doctor to make a preliminary diagnosis about the location and type of the stroke. Laboratory and imaging tests may then help the doctor confirm this diagnosis before giving any treatment.

Last updated:	September 05, 2008