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.