Stroke
Getting a diagnosis of stroke
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.
Initial tests
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...
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...
Her sister told her about a stroke that occurred during an operation. Later she was asked...
Who told me?
Mm hmm.
My sister mentioned it. She said to me and she told me and after she said it to me, I said to myself 'I'll have to let, let it sink in for a while', you know. I'm not going to say, and then after a wee while when I, you know, I gave it a thought and I just accepted it and she was expecting some reaction from me because I remember her saying, 'Oh, she's in denial, she's in denial' but I wasn't in denial at all. I just accepted it. Somehow or other I got the strength to accept it and that's the way I've been ever since. But my husband didn't say very much but he's not, he's well over 80 and he didn't understand very well and my sister and my son didn't want to tell him too much, you know, they didn't want to say to him. So he's still not really understanding it properly I don't think but they were, it was my sister that told me really and then there was some ladies came in afterwards and they were social workers or somebody, I don't know, and they were asking me the queerest questions, you know, about, first of all, they would ask me who, what's the prime minister's name, what's the Queen's name and things like this, you know, probably thinking, 'Is her mind alright?' sort of thing.
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...
His wife found it difficult to watch the sensation tests which involved pinch and pins pricks but...
Well, some of the things, as I say, when I first went to Casualty and this is like things that were reported to me by my wife, they did a lot, they did like a sensation map I think they called it, just to try and suss out where I had any kind of feeling and how much the stroke had taken away the feeling to my left side, so they used just, just pins basically, stabbing my body and pinch me and things just to see if I had any feeling at all down my left side. My wife said, said it was quite awful for her to watch, people pushing needles into my arm and the side of my leg and me just lying there quite happy to let it happen, didn't feel a thing. I had no sensation at all to my left side.
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...
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.to look out.
Explains that a MRI scan was scarier than the CT but music was playing and there was a mirror.to look out.
Yes so the CT scan stands for computerised tomography yeah and then they can tell what's happening if which parts of your brain have been affected yeah? And it's the same with the MRIs they can tell and there was one tiny, tiny spot, a tiny little lesion, and it was said to me that was probably when I've had some high blood pressure.
Right.
Yeah, yes, yes.
And what was it like having those scans?
Well you see this scan is fine, it's kind of like a big wheel you go in there, that's fine but the MRI is very scary because it's like, like a coffin, you go in there and then it closes all in onto you and they play some music and you have got a mirror, you can look there and it's making a lot of noise.
It's like a what?
Making, it's making a lot of noise.
No you said it was like something, it was like a?
It was like a coffin.
Oh a coffin
A coffin it's all closing in onto you and of course if you are claustrophobic like me, I am claustrophobic and when I had my very first MRI scan I did the Lord's Prayer very fast, Our Father in heaven, hallowed be they name, very, very fast.
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...
Describes the carotid Doppler scan which measures blood flow in arteries of the neck. He had a...
Oh no. Well, it was like it, it's like a little microphone and they put it against here like that phew, phew, you know, it, its obviously picking, they're measuring the blood flow through there and what you hear is phew, phew, phew, phew, phew, phew and of course that is transmitted to the monitor and you can see where the whole thing, it's, I don't know how when they actually a camera of sorts and then you can certainly feel, you can see it going through like that and she said to me, 'Oh yes, that's blocked that's clearly blocked it's not getting round. We'll try in different positions like that', and it's there apparently here (pointing to neck) and she said, 'Yes, that's blocked' and I'm told that you think, well if, I'm told if you if you can get it quickly, they can give some sort of a drug that will disperse it but I think in my case, it was totally blocked.
Now, one doctor came to look at me and he said, 'Well', he said, 'Sometimes it isn't a block in the, in the actual arteries. It's sometimes there's a piece of the artery gets flakes off, not flakes off but it, it sort of comes off like a flap on the artery and, and it then comes across like that and blocks like a non return valve of some sort' He said, he said, 'It could be that' he said. Because there's no reason why I'd had a block in, in there at all, he said, because it seems to me as, he said it could be the reason why it did that, it was a flap'. But there again my own doctor said he said it may be the case but there again they had the eye later which suspects that probably there's something floating around in the actual system so I, we said OK, well, it might be a thought, I thought, maybe a thought but I don't think it was the case. It was something blocked but what it does, although it's blocked the blood has to go somewhere and it, apparently it finds other ways round to get the, into the brain, you know, it gets in the and, and that's what happened. So that's why you get a bit better but I know no more than that at all, that's all I know.
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...
A carotid Doppler scan of neck arteries revealed that surgery may help to restore blood flow and...
You just like down and they put the, put the cream on your, on your neck and they, they rubbed this thing over and I could see the, the, the screen, the picture on the screen, they were moving it about and they were taking shots and recording of it and that was painless and the girl was quite informative. She told me everything what, what they were doing and, of course, they look at, the doc, the specialists look at these and decided that an operation was necessary to clear the artery out because of build up, of obstruction in there.
Other tests
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.
She said that the angiogram was a weird sensation but not painful.
So with the angiogram, do you have to have any anaesthetic or do they give you a sedative or anything?
No nothing. They like you awake so it's quite a weird sensation. As a nurse, I can watch the monitor and know exactly where they are. I can't say I actually felt the catheters because arteries don't have nerve endings for that but you can see it on the monitor and when they inject the dye, the radiologist will say, 'It will feel warm behind your right eye', and he injects the dye and you see the dye going through and, yes, it does feel warm behind your right eye but, no, no anaesthetic, no sedative, could have done with a double Scotch at the time [laughter] but fairly painless.
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 he'd had a stroke because he was worried about...
He was very unhappy when he was told that he'd had a stroke because he was worried about...
I was on the stretcher at that time, you know, when he told me, 'You've got a stroke'.
It is not very happy news, you know. I got a stroke and I still am, am the stroke person, you know. I could not move this hand' Totally disable' could not walk myself' Some person have to look after me, you know. Otherwise that is the, that is the, the most dangerous thing happen with the human being. Stroke is the worst thing.
Explains that she just accepted the diagnosis even though it was clear that she would not be able...
Explains that she just accepted the diagnosis even though it was clear that she would not be able...
Well, you just accept it. It has affected your speech and your memory, everything's affected by it and also your mobility. I mean, I drove a car, I, you know, I was a member of the, you know, all different associations. That all goes by the book, I mean, you lose all that, which is a pity.
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...
Michelle found out that she had a stroke from her father. She was frustrated by the lack of...
Last reviewed June 2017.
Last updated August 2013
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