Diagnosis
First of all, a precise description of the symptoms and their temporal progression is necessary: the attending physician asks in the context of the collection of the medical history whether risk factors for arteriosclerosis such as smoking, high blood pressure, lack of exercise and overweight are present. He also inquires about any heart disease or other previous illnesses of the patient in order to obtain a comprehensive picture of him. A neurological examination is performed, paying particular attention to the type and location of the functional deficits, as this information can give the examining doctor an indication of the area of the brain affected by the reduced supply.
The function of the 12 cranial nerves is checked in various tests such as the bilateral pupil reflex of the eyes, the mobility of the tongue or the motor function of the facial muscles. The reflexes of the arms and legs are checked, paying particular attention to any differences between the two halves of the body. An examination by an internal medicine physician serves to investigate the cause of a stroke: special attention is paid to the examination of the heart and vessels to find possible sources of embolism.
Thrombi that form in the heart, detach and are transported into the head vessels can occur in atrial fibrillation or after a heart attack. An ultrasound examination of the heart (= echocardiography) shows the interior of the heart, heart valves and heart walls and can reveal a thrombus. The cervical vessels can be constricted by a thrombosis, which is why the cervical vessels should be listened to on both sides and an ultrasound examination should be performed to show the vessel walls and the blood flow in the vessel.
A computer tomography image of the skull provides an image of the brain tissue and the bony skull. Different shades of gray of the tissue may indicate a bleeding or a reduced blood supply. In the early stages of a stroke, the affected tissue appears lighter in comparison to the healthy environment (= increase in density in the CT), but after 24 hours it is darker (= decrease in density in the CT image).
Bleeding generally appears darker than the surrounding healthy tissue. Magnetic resonance imaging (MRT) is also possible. MRI shows vessels very well, which is why vascular malformations are easy to diagnose with this technique and can provide additional information.
- When did the symptoms start?
- How do the complaints express themselves?
- Have they worsened or improved since their appearance?
- Have there been other complaints in the course of the initial symptoms?