Template:Stroke workup

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 Recommendation)
- Carotid US/CTA/MRA in patients with high short-term risk for stroke (ACEP Level B Recommendation)
Labs
- POC glucose
- CBC
- Chemistry
- Coags
- Troponin
- T&S
ECG
Also consider:
- Pregnancy test
- CXR (if infection suspected)
- UA (if infection suspected)
- Utox (if ingestion suspected)

↑ 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.
↑ Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.
↑ 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.
↑ ACEP Clinical Policy: Suspected Transient Ischemic Attackfull text