Diagnostic studies : Stroke

Diagnostic studies

Diagnostic studies are done to
- Confirm that it is a stroke
- Identify the likely cause of stroke
MRI or non-contrast CT scan
- Indicate size and location of lesion
- Differentiate between ischemic and hemorrhagic stroke
Other studies
- CTA or MRA
- Cerebral angiography
- Digital subtraction angiography
- Transcranial Doppler ultrasonography
- Lumbar puncture
- LICOX system
- Cardiac imaging

Emergency management

Etiology	Assessment finding	Interventions
Sudden vascular compromise causing disruption of blood low to brain Thrombosis Trauma Aneurysm Embolism Hemorrhage Arteriovenous malformation	Altered level of consciousness Weakness, numbness, or paralysis of portion of body Speech or visual disturbances Severe headache Heart rate increase or decrease Respiratory distress Unequal pupils Hypertension Facial drooping on affected side Difficulty swallowing Seizures Bladder or bowel incontinence Nausea and vomiting Vertigo	Initial
		If unresponsive, assess circulation, airway, and breathing. If responsive, monitor airway, breathing, and circulation. Call stroke code or stroke team. Remove dentures. Perform pulse oximetry. Maintain adequate oxygenation (SaO2 >95%) with supplemental O2, if necessary. Establish IV access with normal saline. Maintain BP according to guidelines (e.g., Cardiac Life Support).* Remove clothing. Obtain CT scan or MRI immediately. Perform baseline laboratory tests (including blood glucose) immediately, and treat if hypoglycemic. Position head in midline. Elevate head of bed 30 degrees if no symptoms of shock or injury. Institute seizure precautions. Anticipate thrombolytic therapy for ischemic stroke. Keep patient NPO until swallow reflex evaluated.
		Ongoing monitoring
		Monitor vital signs and neurologic status, including level of consciousness (NIH Stroke Scale), motor and sensory function, pupil size and reactivity, SaO2, and cardiac rhythm. Reassure patient and family.