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Determining the cause of a stroke

Once you have had a stroke, you are likely to have another one. It’s important to uncover why your stroke occurred to prevent future strokes. 

Your stroke work-up includes: 

  • Brain tissue scan(s)
  • Brain and neck blood vessels scan(s) 
  • Heart function and rhythm tests 
  • Blood tests

Brain tissue scan 

Examining the brain tissue helps determine exactly where and how much brain has been damaged. Finding the location often indicates why the stroke occurred. 

  • CT (computed tomography) scan: Provides a picture of your brain. It will show blood in the brain immediately, but usually doesn't show dead tissue until hours later. 
  • Magnetic resonance imaging (MRI): This is a more sensitive scan that identifies areas in your brain lacking adequate blood flow. It also allows the doctor to see soft tissues changes earlier. 

Brain and neck blood vessels scan(s)

A blockage in any of the vessels in or leading to the brain may lead to decreased blood flow to the brain. This can be caused by narrowing of the arteries or from a piece of plaque breaking free, traveling into the brain and causing a blockage. 

  • CT angiogram (CTA) and/or MR angiography (MRA): Uses special dyes injected through the vessels to reveal areas of narrowed blood flow in the brain and neck. 
  • Cerebral angiogram: A minimally invasive procedure in which a catheter is inserted through the groin and threaded up through a vessel to the brain to evaluate the structure of the brain vessels.
  • Carotid ultrasound: Uses non-invasive sound wave technology to evaluate blood vessels from the neck to the front part of your brain (carotid arteries) to inspect for narrowing or blockages.

Heart testing

It is important to look at the heart for any signs of abnormality that could possibly cause a blood clot to form there, such as an abnormal heart rhythm or a hole in the heart (PFO)*. If an abnormality is found, you may be started on blood-thinning medications to prevent future clots. 

  • EKG: An electrocardiogram monitors the heart rhythm and detects abnormalities. An abnormal rhythm called atrial fibrillation (A-fib) allows blood clots to form in the chambers of the heart, and should be treated 
  • Echocardiogram: An ultrasound of the heart done through the chest wall can diagnose structural abnormalities, such as valve defect or disease, congestive heart failure, heart muscle deficiency and congenital abnormalities.
  • Transesophageal echocardiogram: This ultrasound of the heart is performed with a probe inserted into the esophagus. The esophagus is located just behind the heart, providing a clearer image of the back and sides of the heart. 

Blood tests

Blood tests help evaluate potential causes of the stroke. 

  • Unhealthy cholesterol levels
  • Diabetes 
  • Blood clotting disorders
  • Organ dysfunction