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Inpatient care

Following diagnosis of a stroke and initial treatment, stroke patients are usually admitted to the hospital into an intensive care unit or neurological unit, depending on their condition. The purpose of this hospital stay is to identify the cause of the stroke, monitor heart function, and prevent or treat the development of any stroke-related medical complications. Once specific cause and risk factors have been identified, a strategy for prevention can be chosen.

In the hospital, doctors can further evaluate the patient’s condition to determine the best treatment and recovery plan. Additional tests may help identify what caused the stroke and any contributing risk factors.

Imaging tests

Imaging tests may be performed in the hospital to determine the extent of injury to the brain and to discover the nature of the blood vessel problem that resulted in this injury.

  • Magnetic resonance imaging (MRI).  An MRI uses large magnets and radiofrequency waves to produce a three-dimensional view of the brain. An MRI is most sensitive in detecting areas of the brain injured and the severity of injury with an ischemic stroke.
  • Magnetic resonance angiography (MRA).  An MRA is a MRI study of the blood vessels. It uses the same technology as an MRI to produce a three-dimensional view of the blood vessels. An MRA allows your doctor to see any changes in the blood vessels, such as blockages or narrowing or abnormalities that weaken the blood vessel wall (such as aneurysms or AVMs). Contrast dye may or may not be required.
  • Computerized tomography angiography (CTA).  A CTA is a type of CT scan. It uses CT technology to produce a three-dimensional view of the blood vessels. Intravenous contrast dye is required to create this view. It is an alternative to MRA for viewing blood vessel narrowing, blockage, or other blood vessel abnormalities.
  • Carotid ultrasound.  A carotid ultrasound uses sound waves to see the carotid arteries in the neck and the blood flow through them. Although only a limited part of the brain circulation can be viewed with this test, it does offer another noninvasive way to detect narrowing of the carotid arteries in the neck.
  • Cerebral angiography.  This test is sometimes required to offer a more detailed view of the blood vessels. A catheter is inserted into an artery in the groin and then guided up to the blood vessels that serve the brain. Contrast dye is then injected and X-ray pictures of the blood vessels are taken as the dye is moving through the brain blood vessels.

Heart tests

  • ECG (electrocardiogram). An ECG records the electrical activity of the heart through small patches placed on the chest. It allows the doctor to tell if there has been a heart attack, irregular heartbeat or other heart problems which may have contributed to stroke.
  • Echocardiogram. An echocardiogram is a picture of the heart using ultrasound (sound waves). It is used to evaluate the structures of the heart, the pumping function of the heart and the heart valves. It allows the doctor to see how well the heart is working, and to see if there are any blood clots in or near the heart.
  • Transesophageal echocardiogram (TEE). A TEE is an echocardiogram that is done from inside the esophagus (the tube leading from your mouth to your stomach). Because the esophagus lies just behind your heart, the TEE can provide a much clearer image of the heart than the standard echocardiogram. 

Blood tests

The doctor may order blood tests during a stroke patient’s hospital stay. A stroke cannot be diagnosed by a blood test alone. However, these tests can provide information about stroke risk factors or medical conditions that may impact treatment. Some of the testing done might include the following:

  • Lipid testing(Lipid Fasting Profile). Lipid is the scientific name for a fatty substance. Cholesterol and triglyceride are two kinds of lipids carried through the blood. Having too much cholesterol or triglyceride in the blood increases risk for stroke and heart disease.
  • Diabetes screening. A fasting blood glucose is used to help in the diagnosis of diabetes, which is a risk factor for stroke. 

While in the hospital, many stroke patients begin a stroke rehabilitation program. Rehabilitation helps stroke survivors relearn skills that may be lost when part of the brain is injured, and is a vital part of the recovery process.