Template:Stroke workup

Stroke Work-Up

• 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%
  • In acute ICH the sensitivity is 95-100%
  • The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)
• Also consider:
  • CTA brain and neck (to check for large vessel occlusion for potential thrombectomy)
  • Pregnancy test
  • CXR (if infection suspected)
  • UA (if infection suspected)
  • Utox (if ingestion suspected)

MR Imaging (for Rule-Out CVA or TIA)

• MRI Brain with DWI (without contrast) AND
• Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):
  • MRA brain (without contrast) AND
  • MRA neck (without contrast)
    • May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)