Template:Stroke workup: Difference between revisions

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**In acute ICH the sensitivity is 95-100%<ref>Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.</ref>
**In acute ICH the sensitivity is 95-100%<ref>Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.</ref>
**The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)<ref>Douglas VC, Johnston CM, Elkins J, et al. Head computed tomography findings predict short-term stroke risk after transient ischemic attack. Stroke. 2003;34:2894-2899.</ref>
**The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)<ref>Douglas VC, Johnston CM, Elkins J, et al. Head computed tomography findings predict short-term stroke risk after transient ischemic attack. Stroke. 2003;34:2894-2899.</ref>
*[[MRI Brain]] DWI and cervical vascular imaging predict short-term risk for stroke in patients presenting with suspected TIA<ref name="ACEP">ACEP Clinical Policy: Suspected Transient Ischemic Attack[https://www.acep.org/Physician-Resources/Policies/Clinical-policies/Clinical-Policy-Suspected-Transient-Ischemic-Attack/ full text]</ref>. When feasible, physicians should obtain:
**MRI with DWI/MRA in patients with high short-term risk for stroke (ACEP Level B)
**Carotid US/CTA/MRA in patients with high short-term risk for stroke (ACEP Level B)
***Carotid US is slightly less sensitive than MRA, but useful for carotid stenosis eval<ref>Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis. Accuracy of noninvasive testing. Stroke. 2002;33:2003-2008.</ref> (ACEP Level C)
*Also consider:
*Also consider:
**Pregnancy test
**Pregnancy test
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**UA (if infection suspected)
**UA (if infection suspected)
**Utox (if ingestion suspected)
**Utox (if ingestion suspected)
{{MR studies CVA/TIA}}

Revision as of 18:19, 18 February 2017

Stroke Work-Up

  • Labs
    • POC glucose
    • CBC
    • Chemistry
    • Coags
    • Troponin
    • T&S
  • ECG
    • In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes
  • Head CT (non-contrast)
    • In ischemia stroke CT has sensitivity 42%, specificity 91%[1]
    • In acute ICH the sensitivity is 95-100%[2]
    • The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)[3]
  • Also consider:
    • Pregnancy test
    • CXR (if infection suspected)
    • UA (if infection suspected)
    • Utox (if ingestion suspected)

MR Imaging (for Rule-Out CVA or TIA)

  • MRI Brain with DWI, ADC (without contrast) AND
  • Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):[4]
    • MRA brain (without contrast) AND
    • MRA neck (without contrast)
      • May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA)[5] (ACEP Level C)
  1. ↑ Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology. 2002 Aug;224(2):353-60.
  2. ↑ Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.
  3. ↑ Douglas VC, Johnston CM, Elkins J, et al. Head computed tomography findings predict short-term stroke risk after transient ischemic attack. Stroke. 2003;34:2894-2899.
  4. ↑ ACEP Clinical Policy: Suspected Transient Ischemic Attack full text
  5. ↑ Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis. Accuracy of noninvasive testing. Stroke. 2002;33:2003-2008.
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