Template:Stroke workup: Difference between revisions
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***Determine if there is carotid stenosis that warrants endarterectomy urgently
***Determine if there is carotid stenosis that warrants endarterectomy urgently
**Pregnancy test
**Pregnancy test
**CXR (if infection suspected)
**[[CXR]] (if infection suspected)
**UA (if infection suspected)
**[[UA]] (if infection suspected)
**Utox (if ingestion suspected)
**[[Utox]] (if ingestion suspected)


{{MR studies CVA/TIA}}
{{MR studies CVA/TIA}}

Latest revision as of 01:13, 2 October 2019

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:
    • CTA brain and neck
      • To check for large vessel occlusion for potential thrombectomy
      • Determine if there is carotid stenosis that warrants endarterectomy urgently
    • 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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