Diagnostics

Computed tomography (CT)

A computed tomography (CT) of the head in the acute phase of stroke can help the physician to find out whether the stroke is caused by bleeding or by a vascular occlusion (ischemia). Due to its wide availability CT is the standard in the diagnosis of acute stroke. The simple native CT in acute stroke is now supplemented in many hospitals by vascular imaging with CT (CT angiography) and measurement of blood circulation (perfusion CT). These techniques allow more detailed examinations to detect which blood vessel is sealed and the extent to which the brain tissue is affected by the reduced blood flow.  


Magnetic resonance imaging (MRI)

In specialized centers, magnetic resonance imaging (MRI) is carried out instead of or in addition to CT. MRI can provide more useful information about the causes and course of tissue damage in stroke. In addition, so-called lacunar infarcts, older infarctions or additional damage (for example cerebral microangiopathy of the brain) can be shown much better with MRI. MRI can also image the vessels (MR angiography) and blood flow (perfusion). Unlike CT, MRI does not work with  X-rays, but with a magnetic field. Examinations can therefore theoretically be repeated numerous times without negative long-term consequences for the patient. Patients with a pacemaker or other metal parts in the body may not be examined.


Doppler and Duplex Sonography

Doppler and duplex sonography can detect, calcification, atherosclerotic deposits, narrowed blood vessels and thrombotic occlusions in the cerebral arteries. The greater the obstruction of a neck vessel, the greater the risk of stroke. With the so-called transcranial Doppler and duplex sonography even vessels within the head can be shown.  


Angiography

Sometimes it is necessary to visualize the vessels with a so-called conventional angiography, whereby an X-ray contrast medium is injected and images are made of the patient’s head and vessels.  


Electrocardiogram (ECG)

Arrhythmia can be detected with a simple ECG (electrocardiogram) and with a long-term or 24-hour ECG. Certain arrhythmias (e.g. atrial fibrillation) can cause small blood clots to form which are washed into the brain and can obstruct a vessel (embolism). Often the physician can already suspect arrhythmias when he feels the patient's pulse or listens to the patient’s heart.  


Ultrasound of the Heart

With these examinations, heart function and can be described and any dangerous blood clots in the heart cavities detected. The ultrasound can be carried out from the outside through the chest (transthoracic echocardiography, TTE) or from the esophagus (transesophageal echocardiography, TEE). The latter is indeed unpleasant, but images the more relevant part of the heart with respect to possible sources of embolisms.

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