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The stages in the investigation of a stroke include:

  • confirmation of the diagnosis

  • establishing the site of the primary pathology

  • identifying factors which may influence management

NICE (1) state that:

  • brain imaging should be performed immediately (ideally the next slot and definitely within 1 hour, whichever is sooner) for people with acute stroke if any of the following apply:
    • indications for thrombolysis or early anticoagulation treatment
    • on anticoagulant treatment
    • a known bleeding tendency
    • a depressed level of consciousness (Glasgow Coma Score below 13)
    • unexplained progressive or fluctuating symptoms
    • papilloedema, neck stiffness or fever
    • severe headache at onset of stroke symptoms

  • for all people with acute stroke without indications for immediate brain imaging, scanning should be performed as soon as possible (within a maximum of 24 hours after onset of symptoms)

If thrombectomy might be indicated, perform imaging with CT contrast angiography following initial non-enhanced CT. Add CT perfusion imaging (or MR equivalent) if thrombectomy might be indicated beyond 6 hours of symptom onset

People with intracerebral haemorrhage should be monitored by specialists in neurosurgical or stroke care for deterioration in function and referred immediately for brain imaging when necessary

Imaging for people who have had a suspected TIA or acute non-disabling stroke (1):

Suspected TIA

  • do not offer CT brain scanning to people with a suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect

  • after specialist assessment in the TIA clinic, consider MRI (including diffusionweighted and blood-sensitive sequences) to determine the territory of ischaemia, or to detect haemorrhage or alternative pathologies. If MRI is done, perform it on the same day as the assessment

Reference:

Last edited 06/2019

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