How to Diagnose Stroke

How to Diganose Stroke
How to Diganose Stroke
       Stroke is a medical emergency condition. Any person suspected of having a stroke should be immediately taken to a medical facility for evaluation and treatment. First, the doctor will ask the patient's medical history if there are danger signs ahead of time and do a physical exam.
If someone has examined a particular doctor, it would be ideal if the doctor is participating in the assessment. Previous knowledge of the patient can improve the accuracy of assessment.
       Just because a person has impaired speech or weakness on one side of the body does not signal the occurrence of stroke. There are many other possibilities that might be responsible for this phenomenon. Other conditions are similar to a stroke include:
• Brain tumors
• brain abscess
• Migraine headaches
• brain hemorrhage either spontaneously or caused trauma
• Meningitis or encephalitis
• Overdose caused certain medications
• The imbalance of calcium or glucose in the body can also cause changes in the nervous system that are similar to a stroke.
        In the evaluation of acute stroke, many things will happen at the same time. When doctors search information patient history and performing a physical examination, a nurse will begin to monitor the patient's vital signs, blood tests and do an ECG (electrocardiogram).
       Part of a standard physical examination is the use of stroke scales. The American Heart Association has published a manual examination of the nervous system to help care providers determine the severity of the stroke and whether aggressive intervention may be required.
     To distinguish the type of stroke include hemorrhagic or non hemorrhagic (ischemic). between them, can be determined based on history, clinical neurological examination, and assessment with a score algorithm stroke, and investigation.

1. Anamnesis
     When you have established as the cause was a stroke, then the next step is to determine the type of stroke is included which, Haemorrhagic stroke or non Haemorrhagic stroke  . For this purpose, history taking should be done as expeditiously as possible. Based on the history, it can be determined the difference between the two, as shown in the table below.

The difference in infarct or ischemic hemorrhagic stroke and hemorrhagic stroke by history
The difference in infarct or ischemic hemorrhagic stroke and hemorrhagic stroke by history

2. Clinical neurological examination
In this searching examination of signs (sign) that appear, when compared between the two will get the following results:

Differences Haemorrhagic Stroke and Ischemic Stroke by signs.
Differences Haemorrhagic Stroke and Ischemic Stroke by signs.

3. Algorithms and assessment with a score of stroke.
There are several algorithms to distinguish stroke among other things:

 3.a. Stroke Algorithm Gadjah Mada University
Stroke Algorithm Gadjah Mada University
Stroke Algorithm Gadjah Mada University

3.b. Determination of the type of stroke by stroke Djoenaedi score
Djoenaedi Stroke Score
Djoenaedi Stroke Score

If score > 20 including hemorrhagic stroke, a score of <20 including non-hemorrhagic stroke. The accuracy of diagnostic scoring system was 91.3% for hemorrhagic stroke, whereas the non-hemorrhagic stroke 82.4%. Diagnostic Accuracy entirely 87.5%.
There is a narrow time limits to prevent an acute stroke with drugs to improve blood supply to part of the brain is missing. Patients need appropriate evaluation and stabilization before any blood clot medicine crusher can be used.

4. Examination Support
       Computerized tomography (CT scan): to help determine the cause of an unexpected stroke, a special x-ray called a CT scan of the brain is often done. A CT scan is used to look for bleeding or a mass in the brain, the situation is very different from the stroke that require different handling. CT scan is useful for determining:
• type of pathology
• location of the lesion
• size of the lesion
• removal of non-vascular lesions
       MRI scan: Magnetic resonance imaging (MRI) uses magnetic waves to create images of the brain. The resulting image is much more detailed MRI when compared with CT scans, but this is not a front-line examination for stroke. if the CT scan can be completed in minutes, MRI takes more than an hour. MRI can be performed later during patient care if finer detail is needed for further medical decision making. People with certain medical devices (eg, pacemaker) or other metal in the body, can not be subjected to a strong magnetic regions of a MRI.
            Another method of MRI technology: MRI scans can also be used to specifically look at the blood vessels in non-invasively (without using pipe or injection), a procedure called MRA (magnetic resonance angiogram). Another method of MRI called diffusion weighted imaging (DWI) is offered at several medical centers. This technique can detect abnormal area a few minutes after the blood flow to the brain stops, where conventional MRI can not detect a stroke by more than 6 hours from the time of the stroke, and CT scans can sometimes detect up to 12-24 hours. Again, this is not a front-line test to evaluate stroke patients.
            Computerized tomography with angiography: use a dye that is injected into a vein in the arm, the image of the blood vessels in the brain may provide information about the aneurysm or arteriovenous malformation. Such abnormalities in brain blood flow can be evaluated with an increase in advanced technology, CT angiography shift the conventional angiogram.
            Conventional angiogram: an angiogram is another test that is sometimes used to see blood vessels. A long catheter tube is inserted into an artery (usually in the groin area) and a dye is injected while x-rays taken at the same time. Although angiogram gives the vascular anatomy of the most detail, but it is also an invasive procedure and is used only when absolutely necessary. For example, an angiogram performed after bleeding if the source of bleeding should be known with certainty. This procedure is also sometimes done for an accurate evaluation of carotid artery condition when surgery to open blocked blood vessels considered to be done.
      Carotid Doppler ultrasound: a method of non-invasive (no injections or the placement of piping) that uses sound waves to show constriction and decreased blood flow in the carotid artery (the main artery in the neck that supply blood to the brain)
          Heart tests: Certain tests to evaluate heart function in stroke patients is often done to find the source of emboli. An echocardiogram is a test with sound waves made by placing a microphone equipment in the chest or down through the esophagus (transesophageal achocardiogram) to see the heart chambers. Holter Monitor together with the electrocardiogram (ECG), but remains attached electrodes to the chest for 24 hours or longer to identify the abnormal heart rhythm.
          Blood tests: Blood tests such as sedimentation rate and C-reactive protein were performed to look for signs of inflammation that may indicate the existence of arterial inflammation. Certain blood proteins that can increase the chances of stroke caused blood coagulation were also measured. This test is done to identify the cause of stroke that can be treated or to help prevent further injury. Blood screening tests look for potential infection, anemia, renal function and electrolyte abnormalities may also be considered.

CT-Scan picture for Ischemic Stroke and Haemorrhagic Stroke
CT-Scan picture for Ischemic Stroke and Haemorrhagic Stroke






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