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Diagnosing strokes by history and physical exam

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Vishal Punwani.

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  • piceratops ultimate style avatar for user Jules Frisby
    How much time does it take for all these tests to get results? It seems like they would take way too much time, and it would already be too late by the time the tests come back positive.
    (7 votes)
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  • piceratops sapling style avatar for user Nina Voight
    Could a registered nurse undertake most of the information gathering for diagnosis?
    (2 votes)
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    • leaf green style avatar for user Joanne
      Yes, registered nurses do that in many countries as their scope of practice. In the U.S. different states determine scope of practice. A nurse can complete additional education and become a nurse practitioner. A nurse practitioner in Oregon may diagnose and prescribe medications, while I believe a NP in California is required to have a doctor's supervision while diagnosing and treating patients.
      (4 votes)
  • leaf green style avatar for user Maria Moores
    The video mentions that severe headache can indicate a hemorrhagic stroke, but wouldn't an ischemic (i.e. thrombotic/embolotic/etc.) also cause a severe headache? Just like, the brain is being damaged in both cases so wouldn't ANY stroke cause a headache?
    (3 votes)
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  • orange juice squid orange style avatar for user Radhika Patel
    If neurons start dying within 4 minutes without oxygen, when do you take patient history?
    (2 votes)
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    • leaf blue style avatar for user dysmnemonic
      As soon as you can see the patient. If they're conscious and able to talk to you, then taking a focused history from the patient can help you to work out how the stroke has happened and where in the brain the problem is. If you can't take the history directly from the patient, then if they have a family member or carer with them you might be able to find out what happened to the patient when they had the stroke, and whether they have any pre-existing medical conditions.
      (2 votes)
  • piceratops tree style avatar for user Assaf Oppenheimer
    Hi, could you please add a part that gets into the details of where the stroke would be or what blood vessels would be affected based on symptoms?

    (2 votes)
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Video transcript

- [Voiceover] If you've had a stroke, or have had any warning signs of stroke, such as a sudden numbness on one side of your body, you'd need to seek immediate medical attention so that a physician could diagnose a few things. First, whether or not a stroke has occurred, Second, how bad the stroke likely is, and third, what the underlying cause of that stroke could be. And again, a stroke is a medical emergency, so you'd be seeking medical attention immediately. So how is a stroke diagnosed? Well it's kind of done in a few steps. The first step is for the doctor to get a detailed medical history. So this means that you, or maybe a family member if you're disoriented or unable to speak, you or your family member would be able to explain to the doctor what happened to make you worried that a stroke might have occurred. After that, the doctor would go on to ask about the symptoms that you experienced. So, whether you had an extreme headache, which may indicate a hemorrhagic stroke. Or maybe you might have had some sudden weakness in your limbs, or in the muscles of your face. Or maybe you might have had problems with your vision or your balance. You'd also be asked questions to check your memory, and your speech, and even your thinking, because any or all of these could be affected in a stroke, depending on which part of your brain has been injured. And on top of all these symptom questions, you'd be asked about any risk factors that you might have for developing a stroke. So you'd be asked about any hypertension that you might have been diagnosed with. Because we know that chronically high blood pressure, hypertension, that predisposes you to particular types of strokes, like hemorrhagic strokes. And you'd also be asked about any heart conditions you might have, like atrial fibrillation or maybe a previous heart attack, because those are both risk factors for stroke as well. Or you'd be asked about high cholesterol or if you smoke, because both of those are some of the major risk factors for stroke as well. So just keep in mind that the first step in diagnosing a stroke is getting a really good picture of what's going on with the patient. And that's done through this medical history, this interview, if you will. The second step is for the physician to perform a full neurological exam on the patient. So what in the world is that? What does that involve? Well, it's not really as scary as it sounds. It's basically just a physical examination of a variety of your neurological functions. And that's to look for any signs that a stroke has occurred. So your motor skills, which is your movement ability, and your sensation of both your upper and your lower limbs would be tested in a few different ways. And then some of your special senses, like your hearing and your vision, would be tested as well. You'd probably be asked to perform some fine motor tasks as well, like writing down a sentence with a pencil. So a nice, full checkup of your movement ability and your sensation of your upper and lower limbs. And based on your symptoms, the doctor can often identify what part of the brain has been injured. So, for example, you might remember that symptoms on one side of the body suggest damage in the opposite hemisphere of the brain. So if you had problems with your left arm, for example, that might suggest that something's going on in the right half of your brain. And as another example, problems with your balance and your walking might suggest damage to your cerebellum. So depending on your symptoms and where they are, it paints a pretty good picture of what part of your brain might have been injured in a stroke. Now, as part of the exam, the doctor will also check your pulse and your blood pressure. And this is partly to look for any underlying heart conditions that might have caused the stroke. So, for example, an irregular pulse might indicate atrial fibrillation, which is one of those heart conditions where your heart doesn't keep a proper rhythm, and that's a major stroke risk factor. Besides your pulse and your blood pressure, your reflexes might be checked as well to see if they were affected by the stroke. Depending on what's going on with your reflexes, particularly whether they're more responsive than usual or even absent, just non-responsive, that gives the doctor even more information about where in the brain your stroke might have affected. So by gathering all this information by talking to you or your family member, and by doing this neurological physical exam, the doctor will be able to get a pretty good idea of what type of stroke might have happened, where in the brain it might be, and how severe it might be. Then after that, further tests to confirm would be ordered. So lab tests such as blood work, and imaging tests such as brain scanning would be ordered to further evaluate and diagnose the possible stroke.