Difference between revisions of "Template:Stroke - choice of investigation"
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===Choice of modality=== | ===Choice of modality=== | ||
*'''[[CT of the head in stroke]]''' is generally the first investigation because of high availability.<ref name=Radiologyassistant-stroke>{{cite web|url=http://www.radiologyassistant.nl/en/p483910a4b6f14/brain-ischemia-imaging-in-acute-stroke.html|title=Brain Ischemia - Imaging in Acute Stroke|website=Radiology Assistant|author=Majda Thurnher}} Published: June 2008</ref> It detects about 60% of infarcts in the first 3 to 6 hours, and almost always thereafter.<ref name=Radiologyassistant-stroke/> | *'''[[CT of the head in stroke]]''' is generally the first investigation because of high availability.<ref name=Radiologyassistant-stroke>{{cite web|url=http://www.radiologyassistant.nl/en/p483910a4b6f14/brain-ischemia-imaging-in-acute-stroke.html|title=Brain Ischemia - Imaging in Acute Stroke|website=Radiology Assistant|author=Majda Thurnher}} Published: June 2008</ref> It detects about 60% of infarcts in the first 3 to 6 hours, and almost always thereafter.<ref name=Radiologyassistant-stroke/> | ||
| − | *MRI of the head is | + | *'''[[MRI of the head in stroke]]''' is generally less available, but preferred if there are no MRI contraindications, and your clinic has established procedures for its performance in acute stroke (if you do not know, it is reasonable to assume that there is not, and do [[CT of the head in stroke|CT]]). |
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| + | Still not sure? See: '''[[CT vs MRI in stroke]]''' | ||
===How soon=== | ===How soon=== | ||
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*Current anticoagulant treatment | *Current anticoagulant treatment | ||
*Any known bleeding tendency | *Any known bleeding tendency | ||
| − | *Depressed level of consciousness (GCS | + | *Depressed level of consciousness of Glasgow coma scale (GCS) of less than 13 |
*Unexplained progressive or fluctuating symptoms | *Unexplained progressive or fluctuating symptoms | ||
*Papilledema, neck stiffness or fever | *Papilledema, neck stiffness or fever | ||
| Line 17: | Line 19: | ||
In case of acute stroke without indications for immediate imaging, it should be performed within a maximum | In case of acute stroke without indications for immediate imaging, it should be performed within a maximum | ||
of 24 hours after onset of symptoms.<ref name=nice/><noinclude> | of 24 hours after onset of symptoms.<ref name=nice/><noinclude> | ||
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==References== | ==References== | ||
{{reflist}} | {{reflist}} | ||
</noinclude> | </noinclude> | ||
Latest revision as of 01:15, 25 December 2018
Choice of modality
- CT of the head in stroke is generally the first investigation because of high availability.[1] It detects about 60% of infarcts in the first 3 to 6 hours, and almost always thereafter.[1]
- MRI of the head in stroke is generally less available, but preferred if there are no MRI contraindications, and your clinic has established procedures for its performance in acute stroke (if you do not know, it is reasonable to assume that there is not, and do CT).
Still not sure? See: CT vs MRI in stroke
How soon
According to UK guidelines, imaging should be performed immediately for people with suspected acute stroke if any of the following apply:[2]
- Indications for thrombolysis or early anticoagulation treatment
- Current anticoagulant treatment
- Any known bleeding tendency
- Depressed level of consciousness of Glasgow coma scale (GCS) of less than 13
- Unexplained progressive or fluctuating symptoms
- Papilledema, neck stiffness or fever
- Severe headache at onset of stroke symptoms.
"Immediately" is defined as 'ideally the next slot and definitely within 1 hour.[2]
In case of acute stroke without indications for immediate imaging, it should be performed within a maximum of 24 hours after onset of symptoms.[2]
References
- ↑ 1.0 1.1 Majda Thurnher. Brain Ischemia - Imaging in Acute Stroke. Radiology Assistant. Published: June 2008
- ↑ 2.0 2.1 2.2 . Acute stroke. UK National Institute for Health and Care Excellence (NICE). Last updated: 18 December 2018}}
