Template:Stroke workup: Difference between revisions

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===[[Stroke (main)|Stroke]] Work-Up===
===[[Stroke (main)|Stroke]] Work-Up===
*[[Head CT]] (non-contrast)
**In ischemia stroke CT has sensitivity 42%, specificity 91%<ref>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.</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>
*[[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 Recommendation)
**Carotid US/CTA/MRA in patients with high short-term risk for stroke (ACEP Level B Recommendation)
*Labs
*Labs
**POC glucose
**POC glucose
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**T&S
**T&S
*[[ECG]]
*[[ECG]]
*[[Head CT]] (non-contrast)
**In ischemia stroke CT has sensitivity 42%, specificity 91%<ref>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.</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>
*[[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

Revision as of 13:43, 17 August 2016

Stroke Work-Up

  • Labs
    • POC glucose
    • CBC
    • Chemistry
    • Coags
    • Troponin
    • T&S
  • ECG
  • 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]
  • MRI Brain DWI and cervical vascular imaging predict short-term risk for stroke in patients presenting with suspected TIA[4]. 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[5] (ACEP Level C)
  • Also consider:
    • Pregnancy test
    • CXR (if infection suspected)
    • UA (if infection suspected)
    • Utox (if ingestion suspected)
  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 Attackfull 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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