Template:Stroke workup

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)

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)

↑ 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 Attack full text
↑ Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis. Accuracy of noninvasive testing. Stroke. 2002;33:2003-2008.