The routine scan of choice for ruling in or out a stroke is a CT scan of the head without contrast. The scan is needed to determine whether the stroke is of a hemorrhagic or ischemic etiology. Knowing what kind of stroke the patient is having determines treatment modality. A CT scan is best for ruling out hemorrhagic stroke. Once that is done, an MRI can be performed later to assess ischemic stroke and the extent of damage caused by the stroke. Other methods such as arteriography and Doppler ultrasounds of the carotid arteries and other arteries can be used later to help determine the exact site of blockage, but this is done after the initial workup. Despite the advances of imaging technology to help diagnose a stroke, the diagnosis of a stroke is still a clinical one that requires good clinical judgment.

Unfortunately, once a stroke has occurred, the effects of the stroke are likely permanent. The mechanism of stroke injury involves lack of perfusion to brain and neural tissue. Once those tissues become ischemic and die, the effects cannot be reversed. For a patient with a stroke, he or she often needs to be admitted into a "stroke unit" for custom care of stroke symptoms. This type of care has been shown to improve survival rates in stroke patients. For ischemic strokes, a new thrombolytic drug, tissue plasminogen activator (tPA), is being used to break up clots that cause strokes. The potential benefit of this is reversal or some or even all of the stroke symptoms. However, using the drug has a certain time frame; clinical studies have shown that tPA's best window of opportunity is within 3 hours of the stroke. After that time frame, administration of the drug is less likely to work well, with each progressing minute reducing the probability of success. In addition, using tPA can lead to unwanted side effects and even deadly complications such as hemorrhagic stroke. For hemorrhagic strokes, a neurosurgical evaluation is needed to determine if acute surgical intervention is required once the bleeding vessel has been isolated. Once the stroke episode has subsided, the focus of treatment is on rehabilitation and supportive care of the symptoms. Thus, prevention of strokes is currently the only surefire way to not suffer the consequences of a stroke.