An Exploration of the investigations used to diagnose stroke
Methods Used to Diagnose a stroke
There are many different tests that can be carried out to help diagnose a stroke. The main way in which they are found is by using brain imaging so that they are able to pick up any visual issues. Brain imaging allows the doctors to understand whether the stroke was ischemic or hemorrhagic. It also allows them to determine how severe it was. Those who have suffered from a stroke must have a brain scan within 24hours to ensure the best diagnosis can be given to them allowing them to recover much better. Other tests are carried out to help the doctors realise the other smaller effects that the stroke has had upon the patient, these tests are smaller and easier to do but are no less important in allowing the stroke to be diagnosed.
Brain Imaging (CT and MRI)
CT and MRI scans are popular methods to carry out brain imaging. CT scan is rather like an X-ray which is more detailed and built up into a 3D image. An MRI scan creates an extremely detailed picture of the patient’s body. Both scans are useful in diagnosis however the particular one carried out depends upon how severe the doctors feel your stroke may have been. Both types of scans have their individual pros and cons as they are appropriate to reach different needs of the patient.
Blood Tests
Blood tests may be taken as these will tell us the person’s cholesterol and blood sugar levels, so that they are able to receive a wider understanding of the possible causes of the patient’s stroke.
Swallow Tests
Patients that have suffered from a stroke often have swallowing problems and as a result swallow tests are important to be carried out because if they are unable to swallow properly it could lead to inhalation of the food into the lungs causing a chest infection and/or pneumonia. It is an easy test of which requires the person to drink a few teaspoons of water- If they do so without choking they will begin to swallow more water. On the other hand if they struggle to swallow only a few teaspoons they will be referred to a speech and language therapist to enable them to receive a better assessment.
Ultrasound
The ultrasound will be used to create images of the neck area to see if there is any blocking or narrowing within the arteries of which are leading towards to brain. An ultrasound scan must have taken place within 48 hours for the best results for the patient.

Catheter Angiography
Catheter angiography is an investigation where a dye is injected into your carotid or vertebral artery allowing the doctors to receive a much more detailed image of the arteries which can be given through a CT or MR angiography.
Echocardiogram
Echocardiogram can produce images of your heart by using an ultrasound placed on the chest area. It involves an ultrasonic probe which is passed down the oesophagus as it is directly behind the heart consequently allowing a clear image of blood clots to be produced.
Ultrasounds, Catheter angiography and echocardiogram are all tests used to produce images or help work out if a patient has any problems with the heart and/ or the blood vessels. These tests are effective by allowing the causes of the stroke to be better determined.
There are however many problems that can arise when trying to diagnose a stroke especially to the extreme demand of imaging methods and tests that the patient needs to take part in for a true diagnosis to be made
Brain Imaging (CT and MRI)
When having a CT scan of the brain, research has shown that they have very few side effects, however if it is necessary to receive any form of dye there is a possibility of an allergic reaction which under some circumstances can be serious but with the right treatment and medication should clear up well. Also during a CT scan any soft tissue analysis is difficult to evaluate due to lack of magnification given through a CT image, this will also be an issue if the stroke region is too small to be viewed. As of these disadvantages of a CT scanner an MRI scan would produce much more accurate viewings. A CT scan is more available than an MRI but is not available immediately as a computer needs to be used to process the information which takes time.
MRI scans will me a more accurate method of treatment for diagnosing a stroke and other conditions, but takes much longer and its availability in the UK especially in smaller hospitals is limited especially under emergency conditions. MRI scans are extremely helpful they allow doctors to determine which area of the brain is damaged after an ischemic stroke. Like CT scans an MRI has very few/no side effects, it does require a dye to be injected into your arm so a better viewing can be seen. An MRI scan is a long process and may require you to lie in a small space for up to an hour.
CT and MRI scans cost the NHS for each use, a CT scan costs approximately £150, and a MRI scan costs an average of £200 each time it is used. CT scans are carried out by radiographers, as healthcare professional that is trained to carry out these specific scans. MRI scans are also carried out by a radiographer however a health professional that has been following the patient since arriving at the hospital is also present this allows the patient to feel more relaxed in the situation as well as allowing an instant viewing to seen to ensure the correct details are extracted from the scan.

Blood Tests
A blood test is generally an easy and quick test to have done and is available in all hospitals; however the results can take up to 2 weeks to be returned which again leaves the stroke patient waiting as the whole diagnosis process is taking longer. Blood tests are generally harmless tests as only small amount of blood is taken; however you may have some patients of who feel dizzy or faint during or after a test. A blood test may cause you to have a small bruised area where the needle was placed into the body. Overall a blood test can be done quickly and results in very few side effects.
Swallow Tests
Likewise with a blood test a swallow test is a rather easy process and can be taken instantly as it is available in all hospitals at any one time. A swallow test requires no machinery and is simply taken by the doctor or nurses that are in charge of the patient at the time. This test’s results simply go by what the professional health staff have witnessed. The test does not allow us to see any proper results but enables us to understand if further action needs to be taken to help the patient recover well, as well as being able to take into account other effects of which have been caused from the stroke.
Ultrasound
An ultrasound is an easy, safe and inexpensive procedure that can be taken place at the patient’s bedside. Ultrasounds are always available in hospitals to enable a quick image to be produced as soon as possible. It has its limitations however because for an effective viewing of the area an ultrasound has to be done as quickly as possible, no longer that 48 hours after the stroke has occurred. As well as this an ultrasound may be an insufficient technique due to poor ionisation conditions as it produces the image through the skull because it’s likely that the vessel causing the blockage will be deep within the brain. In an ultrasound also arteries with slow flowing blood are also hard to image.
Catheter Angiography
A Catheter Angiography is important in allowing more detailed images to be produced of the blood vessels. This test is much more widely available however may not be placed in every hospital and so will mean if a patient is in need for such test in may cause problems for them as they will have to travel to get one done. It can under some circumstances eliminate the need for surgery however if the need still remains it will ensure that it is done more accurately. It does however have its limitations and risks because with such exposure to radiation there is always a possibility of cancer, there is also the possibility that the blood can form a clot on the tip of the catheter blocking an artery so as a result not helping the causes of a stroke in any way at all. Patients that have the tendency to bleed must have the procedure done very carefully.
Echocardiogram
This is a great method for producing images of your heart as it is easily available and does not interfere with the catheter that has been placed inside of the patient. This method uses much less radiation in contrast to the standard X-ray and so has much less effect on the risks involved to the patient as well as that echocardiogram is much cheaper and easy to get hold of, widening its availability and effortlessness in use.

In conclusion there are many investigation methods that are carried out to enable the diagnosis of Stroke, some of which are much more important and those that are much easier done with little time or knowledge needed to get them to work effectively. There are however several limitations and availability issues to some of the investigations carried out. After researching each of the methods it has enabled me to realise that the investigations which produce the most information in helping with the overall diagnosis such as MRI scans, are those that come with the most availability issues which could be down to the extreme expense. As with all the tests there are limitations and risks that need to be considered but on the whole these were limited and the methods would all produce helpful information to guide the medical staff to an effective diagnosis of the patient’s stroke.

References: * http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/diagnosis.html (30/09/13) * http://www.nhs.uk/Conditions/Stroke/Pages/Diagnosis.aspx (30/09/13) * http://www.webmd.com/stroke/guide/stroke-exams-and-tests (30/09/13) * http://stroke.ahajournals.org/content/34/4/1056.long (30/09/13) * http://Strokecenter.org (1/10/13) * www.nhs.uk/Conditions/Blood-tests/Pages/Introduction.aspx (1/10/13) * www.ncbi.nlm.nih.gov/pubmed/9673329 (1/10/13) * www.radiologyinfo.org/mobile/en/info.cfm?pg=angiocath (1/10/13) * uk.answers.yahoo.com › ... › Diseases & Conditions › Other - Diseases (2/10/13) * www.wikipedia.org/wiki/Angiography‎ (2/10/13)