Stroke & Neurointervention Foundation

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Stroke & Neurointervention Foundation

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Home :: Stroke :: Stroke Tests
Stroke Tests
Computed Axial Tomography (CAT Scan, CT Scan)
A CT scan is usually one of the first tests done in stroke evaluation, particularly during an acute stroke in the emergency room. This test can show areas of abnormalities in the brain, and can help determine if these areas are caused by insufficient blood flow (Ischemic stroke), a ruptured blood vessel (hemorrhage), or a different kind of a problem.

CT scans can often show the size and locations of brain abnormalities caused by tumors, blood vessel defects, blood clots, and other problems. However, it’s not always successful in diagnosing stroke. Even while one is having a stroke, it might not be seen on CT scan for several reasons.   In many cases, the involved area of the brain does not appear abnormal for the first several hours after the onset of stroke.  Also, the stroke region may be too small to be seen on CT scan, or it may be in a part of the brain (brainstem or cerebellum), which the CT scan does not image well.  

An intravenous dye (contrast dye) may be given, through injection. This can help to highlight any areas of abnormality in the scan. 
Magnetic Resonance Imaging (MRI, MR)
This test produces very accurate pictures of the brain and its arteries without x-rays. It is useful for detecting a wide variety of brain and blood vessel abnormalities, and can usually determine the area of the brain that is damaged by an ischemic stroke. It can detect minute differences, even between areas that are similar (unlike CAT scans, which are useful in imaging bone and soft tissue, but with less detail).  MRI can often demonstrate brain abnormalities, which are too small or located in regions of the brain that cannot be seen well by CAT scans. Brain MRI is commonly used to detect and diagnose many kinds of abnormalities of the skull, brain, and spinal cord. In addition to stroke, MRI is used to diagnose abnormal growths such as tumors, blood vessel abnormalities, infections, or disorders such as multiple sclerosis.

There are several different kinds of MRI image sequences. Each sequence highlights different aspects of brain tissue. Some sequences (for example, diffusion-weighted MR) are particularly useful for detecting abnormalities in the first few hours after ischemic stroke. MRI can also be used to obtain an image of the blood vessels, which supply the brain (magnetic resonance angiography or MRA).
Cerebral Angiography (Digital Subtraction Angiography -DSA)
Cerebral angiography is considered as the Gold Standard Test and is used to image the blood vessels of the brain. Angiography involves inserting a catheter through the leg artery of the body to inject a dye (a contrast medium) into the vessels of the neck that lead to the brain.  Then regular x-rays are used to image this dye that flows through the blood vessels.  This test is used to detect abnormalities in the brain's blood vessels, such as narrowing, blockage, AVMs, aneurysms etc.  It is usually done after another test (such as a CT scan) has already detected an abnormality.
Carotid Ultrasound (Carotid Doppler, Carotid Duplex)
Carotid ultrasound is a test that shows the carotid arteries (vessels in the neck that provide blood flow to the brain), as well as how much blood flows and how fast it travels through them. Ultrasound waves are used to make an image of the arteries. This image can be used to find out if there is an abnormality or blockage of the carotid arteries that could lead to stroke.  Since the procedure is done without entering the body and does not use dyes or x-rays, there is no risk or pain involved in having a carotid ultrasound.

 
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