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History profiling the timing of neurological eventsfrom the patient or family member.

first ask the patient or a companion what happenedand when the possible stroke symptoms began.

Of particular importance are the pattern of onsetand course of initial neurological symptoms.

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Episodes of transient ischemic attack (TIAor "mini-stroke")

Head trauma Presence of major and minor risk factors

High blood pressure (hypertension)

Diabetes.

Carotid artery stenosis

Cardiac conditions

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Includes general medical examination as well asneurological examination.

Investigation of vital signs and signs of cardiacdecompression is essential.

neurological examination stresses functions of

cerebral hemisphere, cerebellum, cranial nerves, eyesand sensorimotor system.

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Presenting symptoms will help to determine thelocation of the lesion, and comparison of both sides ofthe body reveal side of the lesion.

Bilateral signs are suggestive of brain stem lesion ormassive cerebral involvement.

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Neck flexion

Meningeal irritation secondary to subarachnoidhemorrhage produce resistance and pain with neck

flexion. Palpation of arteries

Both superficial and deep arteries are palpatedincluding temporal, facial, carotid, subclavian,

brachial, radial, abdominal, aorta and lower extremityarteries.

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Auscultation of heart and blood vessels

Abnormal heart sounds, murmur, or bruits may bepresent and indicate increased flow turbulence andstenosis in vessel.

Ophthalmic pressure

abnormal pressure in the ophthalmic artery indicates

problem in the internal carotid artery.

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1) Urinalysis

2) Blood analysis

3) Fasting blood glucose level

4) Blood chemistry profile5) Blood cholesterol and lipid profile

6) Thyroid function test

7) Full cardiac evaluation

8) Echocardiography

9) Lumbar puncture

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CT

MRI

PET (position emission tomography)

Transcranial and carotid Doppler Cerebral angiography

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The first priority will be to determine ischemic orhemorrhagic stroke.

This distinction is critical because the medicine givenfor an ischemic stroke (caused by a blood clot) couldbe life-threatening if the stroke is hemorrhagic(caused by bleeding).

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The first test after a stroke is typically a computedtomography (CT) scan of the brain

which is a series of X-rays of your brain that can showwhether there is bleeding. This test will help yourdoctor diagnose whether the stroke is ischemic orhemorrhagic.

Magnetic resonance imaging (MRI) may also be done

to find out the amount of damage to the brain andhelp predict recovery.

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