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If your doctor thinks you may have had a stroke, he or she will do a thorough physical exam.

If you have had a severe stroke, you may black out. But if you are conscious, the doctor will check how alert you are by asking you simple questions. He or she will probably ask you your name and what the date is. You might also be asked if you know where you are.

Your doctor will then shine a light in your eyes to make sure your pupils respond properly. He or she will also ask you to look left and right, then up and down. You may also be asked to smile or shrug, and the doctor may test whether you can hear quiet noises or feel a gentle touch on your skin.

The doctor will then check your muscles by asking you to squeeze someone's finger, push with your hands or legs, or kick your legs out. Very often people who have had a stroke will be weak on one side of their body, so it's important to test the strength of your legs and arms.

Your doctor will also check your reflexes by tapping your knee and other joints with a little hammer. Someone who has had a stroke may have reflexes that are much faster and stronger than usual.

If you can get out of bed, your doctor may want to see if you can walk properly. He or she will also make sure that your speech is normal, because some strokes make it hard for people to talk. Other tests include asking you to write something simple on a piece of paper, or to remember the names of a few simple objects (like a hat, a car, and a dog) and then say them back to the doctor after a few minutes.

Doctors use brain scans to find out what type of stroke you've had, where it is and to work out what treatment you should have.¹ It is usually best to have a brain scan soon as possible after doctors think you may have had a stroke. You should definitely have a brain scan within 24 hours. But you may have one much more quickly. Scans can show where the stroke has happened and if there are any complications.²

You may get:

• A CT (computerized tomography) scan. You lie down on a bed which moves slowly through the scanner. The scanner takes lots of X-rays of your brain to see if there is anything unusual there. It provides very detailed pictures and may be the only test you need
• An MRI (magnetic resonance imaging) scan. This looks very like a CT scanner. You lie on a bed which moves you through the tunnel of the scanner. The scanner uses a strong magnetic field to get detailed pictures of your brain.¹ You may be given an MRI scan if the results from the CT scan are unclear.²

If doctors think your stroke has been caused by a narrowing or blockage in the main blood vessel supplying your brain, you'll probably be given an ultrasound scan of your neck. This test can be a Doppler test, B-mode imaging or duplex scanning. A build up of fat in the carotid artery can reduce the amount of blood that gets to the brain, or stop it completely. Either of these can cause a stroke.

Ultrasound tests measure the speed at which blood flows through the carotid artery. They are very quick tests and you won't feel any pain. To do the test a radiologist puts an ultrasound probe over your neck in the place where the carotid artery is. Sound waves travel from the probe to the artery and then bounce back, producing a pattern. The radiologist can tell from this pattern how fast blood is moving through the artery. If the artery is narrowed, blood will flow faster. Results from this test will help your doctor decide whether you need surgery to clear the artery.

To learn more, see carotid endarterectomy in our section on stroke prevention.

Doctors can use ultrasound to check how well your heart is working.³ This test is called an echocardiogram (or "echo" for short). An ultrasound probe is moved over your chest where your heart is. It takes about 10 minutes to 15 minutes and it's safe.

Doctors can see how well the valves in your heart are working and how thick the walls of your heart are. They'll also be able to check whether there is a clot in your heart that might have caused a stroke.

If doctors need to get a closer look at your heart, you may be asked to swallow a small probe attached to a wire. The back of your throat will be sprayed to make it numb so it shouldn't hurt when you swallow the probe.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.