Diagnosis as a guide to stroke therapy (original) (raw)
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Actual diagnostic approach to the acute stroke patient
European Radiology, 2006
Since acute stroke is now considered a potentially treatable medical emergency, a rapid and correct diagnosis must be made. The first step is to exclude hemorrhage, then to visualize any early ischemic changes, demonstrate the presence of hypoperfusion and locate the presence of a vascular underlying pathology as well as elucidate the presence of a potential penumbra (tissue at risk). Thanks to improvements and advances in both MR and CT technology, this can now be done in a number of ways. At the moment, CT is the most widely available and fast method for obtaining imaging of the brain and neck vessels of patients presenting with acute stroke. MRI can provide more precise information, although it remains slightly more time-consuming, but is, however, the method of choice for follow-up imaging. The main point is to take the one-stop-shopping approach where imaging of the vessels and brain is done from the aortic arch to the circle of Willis in one single session in order to have all the necessary information in the acute phase.
Stroke and Neurodegenerative Disorders: 1. Stroke Management in the Acute Care Setting
PM&R, 2009
Objective: This self-directed learning module highlights management of stroke in the acute care setting. It is part of the study guide on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on initial assessment and management of acute ischemic and hemorrhagic stroke, descriptions of posterior circulation and lacunar stroke, and criteria for admission to acute inpatient rehabilitation after stroke and secondary stroke prevention. The goal of this article is to improve the learner's ability to identify, treat and manage a patient with a stroke in the acute care setting.
Complementary examinations other than neuroimaging and neurosonology in acute stroke
World journal of clinical cases, 2017
The etiologic diagnosis of cerebrovascular diseases requires non-routine complementary examinations to be performed. Thus, in specific cases, after neuroimaging (computed tomography/magnetic resonance imaging cerebral scan sequences) and neurosonology (Doppler test of the supra-aortic trunks, transcranial echography and echocardiography), which academically allow us to classify the patients according to their etiologic stroke subtype, further examinations must be used to make a correct etiologic diagnostic. The present review aims to update knowledge about the usefulness of the different tests of blood and urine, plain chest radiography, X-ray of the spine, skull and abdomen, lumbar puncture, electroencephalography, evoked potentials, polysomnography, and pathologic examination after biopsy of the artery, skin, muscles, nerves, meninges, and brain, in the management of patients who have suffered an acute stroke.
Circulation, 1994
May be partial loss of the field Vertigo, double vision, unilateral hearing loss, nausea, vomiting, headache, photophobia, or phonophobla Adapted from Cook et al. s Nonphysician EMS Personnel EMS personnel should be instructed in the rapid recognition, evaluation, treatment, and transport of patients with stroke (Table 2). Most strokes can be readily recognized. The immediate diagnostic goal is not to differentiate subtle, unusual, or isolated neurological signs, and every minute may be important; thus, EMS personnel should be able to perform a baseline assessment within a few minutes. 4 Some portions of the evaluation and initial management can be completed while the patient is being transported to the hospital. Notification of the hospital can save valuable time because the physicians, nurses, and technicians who will initiate emergent care and obtain the required studies can be assembled to meet the patient on arrival. In the future, specific therapies to limit the effects of stroke may be administered before a patient arrives in the hospital. Physicians Stroke should be suspected whenever a patient has the characteristic sudden onset of focal neurological TABLE 2. Recommended Assessment of a Person With Suspected Stroke by EMS Personnel
Heart Disease and Stroke a Journal For Primary Care Physicians, 1994
May be partial loss of the field Vertigo, double vision, unilateral hearing loss, nausea, vomiting, headache, photophobia, or phonophobla Adapted from Cook et al. s Nonphysician EMS Personnel EMS personnel should be instructed in the rapid recognition, evaluation, treatment, and transport of patients with stroke (Table 2). Most strokes can be readily recognized. The immediate diagnostic goal is not to differentiate subtle, unusual, or isolated neurological signs, and every minute may be important; thus, EMS personnel should be able to perform a baseline assessment within a few minutes. 4 Some portions of the evaluation and initial management can be completed while the patient is being transported to the hospital. Notification of the hospital can save valuable time because the physicians, nurses, and technicians who will initiate emergent care and obtain the required studies can be assembled to meet the patient on arrival. In the future, specific therapies to limit the effects of stroke may be administered before a patient arrives in the hospital. Physicians Stroke should be suspected whenever a patient has the characteristic sudden onset of focal neurological TABLE 2. Recommended Assessment of a Person With Suspected Stroke by EMS Personnel
Investigation of acute stroke: what is the most effective strategy?
Postgraduate Medical Journal, 1991
Techniques of investigation of acute stroke syndromes have progressed rapidly in recent years, outpacing developments in effective stroke treatment. The clinician is thus faced with a variety of tests, each with different cost implications and each altering management to a greater or lesser extent. This review will concentrate on the basic tests which should be performed for all strokes (full blood count, ESR, biochemical screen, blood glucose, cholesterol, syphilis serology, chest X-ray and electrocardiogram). Additional tests may be required in selected cases: CT scan to diagnose 'non-stroke' lesions, to exclude cerebral haemorrhage if anti-haemostatic therapy is planned, and to detect strokes which may require emergency intervention (such as cerebellar stroke with hydrocephalus); echocardiography to detect cardiac sources of emboli; and in a few cases lumbar puncture and specialized haematological tests. Other tests, which are currently research tools, may be suitable for widespread use in the future including NMR, SPECT and PET scanning.