Stroke diagnostic study of choice: Difference between revisions
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=== Study of choice === | === Study of choice === | ||
There is no single diagnostic study of choice for the diagnosis of stroke. But stroke can be diagnosed based on [[History and Physical examination|clinical presentation]], [[CT scan]], [[MRI]] findings. | There is no single diagnostic study of choice for the diagnosis of stroke. But stroke can be diagnosed based on [[History and Physical examination|clinical presentation]], [[CT scan]], [[MRI]] findings.<ref name="pmid26243819">{{cite journal |vauthors=Musuka TD, Wilton SB, Traboulsi M, Hill MD |title=Diagnosis and management of acute ischemic stroke: speed is critical |journal=CMAJ |volume=187 |issue=12 |pages=887–93 |date=September 2015 |pmid=26243819 |pmc=4562827 |doi=10.1503/cmaj.140355 |url=}}</ref><ref name="pmid16227545">{{cite journal |vauthors=Barber PA, Hill MD, Eliasziw M, Demchuk AM, Pexman JH, Hudon ME, Tomanek A, Frayne R, Buchan AM |title=Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging |journal=J Neurol Neurosurg Psychiatry |volume=76 |issue=11 |pages=1528–33 |date=November 2005 |pmid=16227545 |pmc=1739399 |doi=10.1136/jnnp.2004.059261 |url=}}</ref><ref name="pmid15494579">{{cite journal |vauthors=Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S |title=Comparison of MRI and CT for detection of acute intracerebral hemorrhage |journal=JAMA |volume=292 |issue=15 |pages=1823–30 |date=October 2004 |pmid=15494579 |doi=10.1001/jama.292.15.1823 |url=}}</ref> | ||
*Non-contrast CT scan is fast, widely-available and inexpensive. It can rule in hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) with over 95% accuracy. CT scan also has the ability to rule in massive ischemic stroke in two third of cases, but is is not sensitive for minor ischemic stroke. | *Non-contrast CT scan is fast, widely-available and inexpensive. It can rule in hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) with over 95% accuracy. CT scan also has the ability to rule in massive ischemic stroke in two third of cases, but is is not sensitive for minor ischemic stroke. | ||
*MRI is the most sensitive and specific test for diagnosing ischemic stroke, specially minor ischemic stroke with limited deficits, and may help detect presence of infarction in few minutes of onset of symptoms. | *MRI is the most sensitive and specific test for diagnosing ischemic stroke, specially minor ischemic stroke with limited deficits, and may help detect presence of infarction in few minutes of onset of symptoms. | ||
===Sequence of Diagnostic studies=== | ===Sequence of Diagnostic studies=== | ||
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*Non-contrast CT scan | *Non-contrast CT scan | ||
*MRI | *MRI | ||
== Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association<ref name="pmid31662037">{{cite journal| author=Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K | display-authors=etal| title=Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. | journal=Stroke | year= 2019 | volume= 50 | issue= 12 | pages= e344-e418 | pmid=31662037 | doi=10.1161/STR.0000000000000211 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31662037 }}</ref> == | |||
=== Head and Neck Imaging === | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |'''1.''' All patients with suspected acute stroke should receive emergency brain imaging evaluation on first arrival to a hospital before initiating any specific therapy to treat AIS.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | |||
|- | |||
| bgcolor="LightGreen" |'''2.''' Systems should be established so that brain imaging studies can be performed as quickly as possible in patients who may be candidates for IV fibrinolysis or mechanical thrombectomy or both.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' | |||
|- | |||
| bgcolor="LightGreen" |'''3.''' Noncontrast CT (NCCT) is effective to exclude ICH before IV alteplase administration. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | |||
|- | |||
| bgcolor="LightGreen" |'''4.''' Magnetic resonance (MR) imaging (MRI) is effective to exclude ICH before IV alteplase administration. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' | |||
|- | |||
| bgcolor="LightGreen" |'''5.'''CTA with CTP or MR angiography (MRA) with diffusion-weighted magnetic resonance imaging (DW-MRI) with or without MR perfusion is recommended for certain patients.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | |||
|} | |||
==References== | |||
{{reflist|2}} | |||
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{{WS}} | |||
Latest revision as of 13:56, 19 January 2023
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]
Overview
There is no single diagnostic study of choice for the diagnosis of stroke. But stroke can be diagnosed based on clinical presentation, CT scan, MRI findings.
Diagnostic Study of Choice
Study of choice
There is no single diagnostic study of choice for the diagnosis of stroke. But stroke can be diagnosed based on clinical presentation, CT scan, MRI findings.[1][2][3]
- Non-contrast CT scan is fast, widely-available and inexpensive. It can rule in hemorrhagic stroke (intracerebral or subarachnoid hemorrhage) with over 95% accuracy. CT scan also has the ability to rule in massive ischemic stroke in two third of cases, but is is not sensitive for minor ischemic stroke.
- MRI is the most sensitive and specific test for diagnosing ischemic stroke, specially minor ischemic stroke with limited deficits, and may help detect presence of infarction in few minutes of onset of symptoms.
Sequence of Diagnostic studies
- History and physical exam
- Non-contrast CT scan
- MRI
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[4]
Head and Neck Imaging
| Class I |
| 1. All patients with suspected acute stroke should receive emergency brain imaging evaluation on first arrival to a hospital before initiating any specific therapy to treat AIS.(Level of Evidence: A) |
| 2. Systems should be established so that brain imaging studies can be performed as quickly as possible in patients who may be candidates for IV fibrinolysis or mechanical thrombectomy or both.(Level of Evidence: B-NR) |
| 3. Noncontrast CT (NCCT) is effective to exclude ICH before IV alteplase administration. (Level of Evidence: A) |
| 4. Magnetic resonance (MR) imaging (MRI) is effective to exclude ICH before IV alteplase administration. (Level of Evidence: B-NR) |
| 5.CTA with CTP or MR angiography (MRA) with diffusion-weighted magnetic resonance imaging (DW-MRI) with or without MR perfusion is recommended for certain patients.(Level of Evidence: A) |
References
- ↑ Musuka TD, Wilton SB, Traboulsi M, Hill MD (September 2015). "Diagnosis and management of acute ischemic stroke: speed is critical". CMAJ. 187 (12): 887–93. doi:10.1503/cmaj.140355. PMC 4562827. PMID 26243819.
- ↑ Barber PA, Hill MD, Eliasziw M, Demchuk AM, Pexman JH, Hudon ME, Tomanek A, Frayne R, Buchan AM (November 2005). "Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging". J Neurol Neurosurg Psychiatry. 76 (11): 1528–33. doi:10.1136/jnnp.2004.059261. PMC 1739399. PMID 16227545.
- ↑ Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S (October 2004). "Comparison of MRI and CT for detection of acute intracerebral hemorrhage". JAMA. 292 (15): 1823–30. doi:10.1001/jama.292.15.1823. PMID 15494579.
- ↑ Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K; et al. (2019). "Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. 50 (12): e344–e418. doi:10.1161/STR.0000000000000211. PMID 31662037.