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Ischemia, Cerebral

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Diagnosing Cerebral Ischemia

Rapid evaluation and diagnosis are the cornerstones of successful treatment of cerebral ischemia. A person experiencing the symptoms of cerebral ischemia needs to be examined by a doctor immediately to rule out other conditions that have similar signs and to confirm cerebral ischemia so that proper treatment can be started to reduce the possibility of stroke and further damage to brain tissue.

A diagnosis of cerebral ischemia will start with a doctor finding out a person’s symptoms and performing a physical exam, including checking breathing and circulation, as well as learning the family history. Based on a person’s symptoms and physical findings, a medical team will then likely order specific imaging tests, which will allow them to look inside the body and visualize the arteries and brain to confirm cerebral ischemia, to learn whether a stroke has occurred, and to find out the location of the blockage.

Some of the following blood tests are often ordered to help with the diagnosis of cerebral ischemia:

  • A serum-glucose test may be performed if a person seems confused and has slurred speech to rule out blood-sugar problems, which have similar symptoms.
  • Serum electrolytes may be checked, since abnormalities could lead to neurological symptoms that could be confused with cerebral ischemia.
  • Serum BUN and creatinine levels can rule out kidney failure, which would alter treatment of cerebral ischemia.
  • Cardiac enzymes are evaluated to see whether a person has suffered a heart attack.
  • An electrocardiogram (ECG) may be requested to check for abnormal heart rhythms.
  • A CBC (complete blood count) measures several features of a person’s blood.
  • Prothrombin time (with INR) test measures how quickly blood clots.         

Imaging tests are likely to be performed to visualize blockages in arteries. Common imaging tests that may be ordered:

  • An ultrasound, which uses sound waves to produce an image, is a noninvasive way to view the arteries. This image can reveal whether there is a blockage or clot.
  • An angiogram (an X-ray using injected dye) can show whether an artery is damaged or blocked.
  • An echocardiography uses sound waves to produce an image of the heart.
  • A CT scan (X-rays and computer-generated 3-D images) of the head can visualize a hemorrhage or a brain tumor, which can also cause brain-tissue death.
  • An MRA (magnetic resonance angiography) and CT angiogram can allow a radiologist and neurosurgeon to examine blood vessels with precise views.
  • Digital-subtracted cerebral angiogram (DSA) produces the most detailed images of the blood vessels of the brain.
  • Some patients may have a single photon emission computerized tomography (SPECT) scan, which can show the areas of the brain that are being deprived of oxygen.

A CT or MRI scan of the brain can be used to determine whether a stroke has already occurred.

Reviewed by: Dr. Philip E. Stieg
Last reviewed/updated: October 2020