A stroke occurs when the blood supply carrying oxygen and nutrients to part of the brain is cut off or reduced by either a clot in, or a leak from, a blood vessel. Different parts of the brain control different activities like movement, balance, speech, sight, hearing, understanding and memory. Different sides (hemispheres) of the brain control different functions, for example, the right side of the brain controls movement and feeling in the left side of the body and vice versa. Loss of blood to an area of the brain can causes selective loss of the function controlled by that part of the brain. A stroke can often be diagnosed by looking for changes in function or feeling.
Diagnosis, tests and monitoring
In the first few hours and days in hospital after a stroke, assessment, monitoring and treatment are very important because they limit the effects of the initial event, reduces the likelihood of further extension of the brain damage, and prevents complications which can be fatal. Lack of appropriate care at this time can result in increased likelihood of death, as well as the effects of the stroke being much worse than they should have been.
Some people recalled ongoing monitoring of their blood pressure or neurological tests in the first 24 hours. These could sometimes disturb sleep although people found it reassuring that they were near the nurses’ station and were carefully monitored.
In the first few days many people also went through further diagnostic tests establish the cause of the stroke and which parts of the brain had been affected
Problems getting a diagnosis
In some cases, individuals had a difficult time getting a diagnosis. Some individuals signs were dismissed as minor ailments (i.e., headache) and they were sent home. They were not given medical attention for stroke until the signs persisted.
Tests to diagnose a stroke are usually conducted as soon as the person seeks medical help. Tests include neurological tests for reflexes, movement, sensation, vision and mental understanding. Some also had a CT (computerised axial tomography) scan at this stage. A CT scan should be done at once although this was not always the case (see below). Some people also had tests to identify the cause of their stroke including blood pressure and blood tests for cholesterol, clotting and blood sugar.
Most people had these tests although some found them difficult to recall as they described feeling ‘pretty out of it’ at the time.
As high blood pressure is a major risk factor for stroke, blood pressure was routinely checked. In most cases high blood pressure did not require immediate action. A few people, however, told us that their blood pressure was exceedingly high and were given medication to stabilise it quickly.
In casualty his blood pressure was found to be very high so he was immediately given medication…
A few recalled questions to test their memory and understanding such as ‘Who is the prime minister?’ ‘What date is it’ or being asked to recall their address or do simple maths. These are part of a standard test to identify whether memory parts of the brain are affected. Some commented that they may have struggled with some answers even before the stroke – this is taken into account in people’s responses.
Her sister told her about a stroke that occurred during an operation. Later she was asked…
Tests of sensation sometimes involved using pins or pinching the person to see if one side of the body is numb.
His wife found it difficult to watch the sensation tests which involved pinch and pins pricks but…
In a few cases initial tests failed to pick up a stroke usually when the person was younger or the symptoms were unusual. A young woman who had unusual visual symptoms was sent home with a suspected migraine. It was later recognised that she had had a stroke after her husband saw a poster on stroke and asked for further tests.
The hospital initially diagnosed migraine but later her husband saw a poster on stroke and…
Test of the heart and circulation
Initial tests sometimes looked at heart function and other parts of blood circulation. These are carried out because a stroke can be due to a clot that has formed in the heart. Tests include chest x-rays, echocardiogram (echo) and electrocardiogram (ECG). Two younger people had specific tests later on to look for a hole in the heart, which can sometimes cause a stroke.
Brain scans – MRI and CT
Most of the people went on to have either a CT (computerised axial tomography) scan or MRI (magnetic resonance imaging) scan of the brain to confirm the diagnosis of stroke. Scans identify the cause (clot or bleed) and show the areas of the brain that have been affected. These scans were usually carried out within days of the stroke although a few people had to wait longer. Because it is recommended that scans are carried out within 24 hours if not immediately for more severe symptoms, some people found the wait annoying.
In a CT scan you lie on your back with your head inside the scanner. Dye may be injected so the results can be seen more clearly. Most people found CT scans okay, although for both types of scan it is important to stay still, which was sometimes difficult when people were feeling unwell.
During an MRI scan you lie on your back and go into an enclosed tunnel; the machine is quite noisy. While some people found this okay, others found it upsetting, particularly if they felt claustrophobic. Most people realised that it was something you just had to get through and used different distraction strategies – one woman mentally went through the clothes in her wardrobe, another prayed. Sometimes there was music playing to mask the noise and a mirror to look outside of the scanner. Most people were given a panic button to stop the test.
Explains that a MRI scan was scarier than the CT but music was playing and there was a mirror….
Vascular scan of carotid arteries
Sometimes a stroke is caused by a clot which results from ‘furring up’ of the carotid arteries on either side of the neck. If this was a suspected cause of the stroke then people usually had a carotid Doppler scan (carotid ultrasound). In this test gel is placed on the neck and a small ultrasound probe is passed over the skin. Sound waves which are audible to the patient and visible on a screen detect the blood flow. Several people described the sound of the test and the anticipation of waiting for the next pulse of blood.
Describes the carotid Doppler scan which measures blood flow in arteries of the neck. He had a…
People who had been having Transient Ischaemic Attacks (TIA’s) were sometimes offered an operation to clear a blockage – carotid endarterectomy (see ‘Surgery‘). Unfortunately, if a full stroke has occurred, surgery will not help restore function.
A carotid Doppler scan of neck arteries revealed that surgery may help to restore blood flow and…
People who have had a brain haemorrhage sometimes had tests to look for a malformation in the blood vessels of the brain. In an angiogram a dye is injected into the brain through a catheter inserted in the groin area. The site of the injection is numbed but you are usually awake. Both people that we spoke to who had an angiogram found it relatively painless.
She said that the angiogram was a weird sensation but not painful.
Reaction to the diagnosis
People reacted differently to their initial diagnosis. Some said that they did not react because they were too ‘out of it’. Many were shocked, expressed disbelief at what had happened, or found it difficult to accept. Others were confused, angry and upset and some cried a great deal. Some initially underestimated the severity of what had happened to them. A few said they just accepted it.
He was very unhappy when he was told that hed had a stroke because he was worried about…
Explains that she just accepted the diagnosis even though it was clear that she would not be able…
Most individuals were given the diagnosis directly while others heard from family members. A woman who experienced a stroke in her twenties was quite frustrated that her diagnosis was not adequately explained to her and that the information went to her father first.
Michelle found out that she had a stroke from her father. She was frustrated by the lack of…