How is Stroke Diagnosed?


If your doctor suspects you’ve had a stroke, they will perform tests to rule out other conditions with similar symptoms and determine exactly where a stroke occurred and what type of stroke it was. Tests may include:

  • Physical exam: Your physician will likely begin with a physical exam, looking for signs of muscle weakness or numbness, loss of coordination or balance, trouble speaking or seeing, and signs of confusion
  • CTA (computed tomographic angiography): A CTA can give your doctor an image of your blood vessels, helping them locate any areas of blockage or rupture
  • Magnetic resonance imaging (MRI): An MRI can help your doctor find small changes in brain tissue caused by a stroke
  • Computerized tomography (CT scan): A CT scan can provide detailed images of the brain and show your physician where brain bleeding or cell damage has occurred
  • Magnetic resonance angiography (MRA): An MRA can help show your doctor how blood is flowing through your arteries

How is Stroke Treated?


Your doctor will create a stroke treatment plan for you that will vary based on many factors, including the type of stroke, when and where it occurred, its severity, and your overall health and medical history.

Ischemic stroke treatment

To treat an ischemic stroke, a doctor will attempt to restore blood flow to the brain as quickly as possible by alleviating the blockage in your blood vessel. Methods that may be used include:

  • IV medications: Medicines that can dissolve a blood clot and restore blood flow to the brain can improve your chances of surviving a stroke and decrease your risk of complications. These drugs, called tissue plasminogen activators (tPA), are administered through an IV and must be given within 4.5 hours of the stroke to be effective.
  • Emergency endovascular procedures: Endovascular treatment is used for ischemic strokes that do not resolve with tPA, or in patients for whom tPA is no longer a treatment option. A doctor can use "mechanical clot extraction," inserting a special device through a flexible tube to remove the clot and restore blood flow.
  • Carotid endarterectomy: This procedure removes a buildup of plaque inside the carotid artery (the artery running along the neck that supplies blood to the brain)
  • Angioplasty and stents: During this procedure, your physician will thread a catheter into the carotid artery and inflate a balloon to widen the narrowed blood vessel. They will then insert a stent to support the newly widened artery.

Hemorrhagic stroke treatment

Treating hemorrhagic stroke revolves around reducing excess blood in the brain, along with relieving pressure in the brain caused by the extra fluid. Treatment methods include:

  • Drug therapies: To enhance healing and recovery for patients with hemorrhagic stroke, your care team will work to control high blood pressure, normalize blood clotting, control brain swelling, enhance the flow of oxygen-rich blood to brain tissue near the injury, and regulate brain temperature to normal or below-normal levels to protect brain tissue with various types of medicines
  • Traditional surgery: For patients with large brain hemorrhages, a doctor will perform surgery to relieve pressure in the skull caused by bleeding. If the stroke resulted from a weakened area in a blood vessel wall (an aneurysm) or a defective blood vessel, the surgeon will repair these areas to prevent further strokes. They may also be able to redirect blood flow to other vessels that supply blood to the same region of the brain.
  • Surgical clipping: A doctor may place a surgical clamp at the site of the hemorrhage to stop the bleeding
  • Coiling (endovascular embolization): A physician threads a catheter to the brain through the groin and places several small coils at the site of an aneurysm that caused the stroke. This can block blood flow and encourage blood clotting at the site of the hemorrhage.
  • Surgical AVM removal: If your stroke was caused by an arteriovenous malformation (AVM), your doctor may choose to remove it surgically if it is in an accessible part of the brain. This will lower the risk of hemorrhagic stroke and eliminate the possibility of rupture.


The Center for Stroke Rehabilitation at NewYork-Presbyterian Hospital is devoted to providing advanced stroke rehabilitation and developing innovative, effective treatments for stroke survivors. We are committed to providing state-of-the-art treatments that are not widely available at other centers in the New York metropolitan area, and creating and assessing new treatments to improve the lives of people living with the effects of stroke. We believe that introducing a rehabilitation plan as early as possible offers patients the best chance at a successful recovery.

Our multidisciplinary rehabilitation team includes physical therapists, occupational therapists, speech therapists, recreational therapists, and physicians who are fellowship-trained in neurological rehabilitation. Rehabilitation goals may include regaining lost function, building strength and endurance, and improving communication in patients who have lost some ability to speak and gesture.

Rehabilitation is offered on both an inpatient and an outpatient basis, depending on each patient's diagnosis and personal needs, which may require physical therapy, speech therapy, occupational therapy, or other approaches.

Stages of Stroke Recovery

Stages of Recovery

The Brunnstrom Approach offers a way for experts to identify the stages of stroke recovery. This approach describes the sequence of recovery and recuperation of different body functions after a stroke. The Brunnstrom stages of recovery are:

  • Flaccidity: Muscles are weak, limp, and incapable of movement
  • Spasticity appears: Muscles have difficulty relaxing and may tighten or make abnormal spastic movements without warning
  • Increased spasticity: Some muscles may become even tighter and stiffer
  • Decreased spasticity: Muscle tightness and inability to relax may decrease
  • Complex movement combinations: Muscle tightness is minimal, allowing for some deliberate and controlled movement
  • Spasticity disappears and coordination reappears: Motor control increases and all muscle tightness and abnormal movement disappears
  • Normal function returns: Regaining full functionality in muscles affected by stroke


NewYork-Presbyterian is one of the leading clinical research institutions in the country, and our investigators participate in major multi-center national clinical trials to refine stroke management. Patients have the opportunity to participate in a wide range of research studies, including those evaluating cutting-edge acute stroke treatments, stroke prevention, and stroke recovery.

In addition, NewYork-Presbyterian/Columbia is one of eight national recipients of a Specialized Program in Translational Research in Acute Stroke (SPOTRIAS) grant from the National Institutes of Health, and one of four Stroke Prevention/Intervention Research Program (SPIRP) Centers in the United States designated by the National Institute of Neurological Disorders and Stroke.

Examples of research areas include:

  • Studies of new medical and surgical treatments for stroke
  • Studies of how nerve cells grow and regenerate following stroke
  • Functional MRI studies of brain activity during recovery from stroke
  • Identification of risk factors and genetic determinants of stroke



A pre-stroke is one term for a transient ischemic attack (TIA), a type of ischemic event that occurs when blood flow to the brain is blocked only temporarily.

A blood pressure of 180/120 mmHg or above is considered dangerously high and “stroke level.” You should seek immediate medical attention if your blood pressure is at this level.

Some people who suffer a stroke experience a “stroke headache,” a sudden and severe headache that may resemble a migraine. Not all people having a stroke will show symptoms of a headache, however.

If you suspect that you or someone else is suffering from a stroke, call 911 immediately. A stroke is a medical emergency and treatment should be administered as quickly as possible.

Both strokes and heart attacks occur because of a lack of oxygen-rich blood in vital organs. Strokes are caused by blockages of blood to the brain or bleeding within the brain, while heart attacks are caused by blockages of blood to the heart.

NewYork-Presbyterian/Columbia University Irving Medical Center offers a bi-monthly Stroke Survivors support group. Download the flyer for more information and registration details.

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Trust NewYork-Presbyterian for Stroke Treatment

When a stroke happens, the brain damage that occurs can set off a cascade of other complications. That's why it's so important to treat a stroke as soon as possible. NewYork-Presbyterian is home to several stroke centers with the expertise and state-of-the-art therapies needed to evaluate and treat patients promptly. Call today to make an appointment.