Ischemic stroke diagnosis

Recent years have seen the emergence of successful treatment strategies for ischemic stroke, but these are most effective only when initiated within several hours after stroke onset. Therefore, extremely rapid diagnosis and initiation of treatment are critical in avoiding death or severe disability. 

Besides establishing the diagnosis of ischemic stroke, DWI also offers the capability of measuring the approximate age of infarcts. The apparent diffusion coefficient (ADC) of water, a measure of diffusion that can be derived easily from DWI images, follows a typical sequence of changes in evolving infarcts. °" ADC... 

Furlan A, Higashida R. Intra-arterial thrombolysis in acute ischemic Stroke. In Mohr JP, Choi DW, Grotta JC, et al., eds. Stroke Pathophysiology, Diagnosis, and Management. 4th ed. Philadelphia, PA Churchill Livingstone 2004 p. 943-951. 

Assessment of risk factors for ischemic stroke as well as for hemorrhagic stroke is an important component of the diagnosis and treatment of patients. A major goal in the long-term treatment of ischemic stroke involves the prevention of a recurrent stroke through the reduction and modification of risk factors. The major focus of primary prevention (prevention of the first stroke) is also reduction and modification of risk factors. Risk factors for ischemic stroke can be divided into modifiable and non-modifiable factors. Every patient should have risk factors assessed and treated, if possible, as management of risk factors can decrease the occurrence and/or recurrence of stroke.4... 

Alteplase (rt-PA Activase) is an IV thrombolytic (fibrinolytic) that was approved for acute stroke treatment in 1996 based on the results of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial.10 The current American Stroke Association guidelines include alteplase as the only Food and Drug Administration (FDA) approved acute treatment for ischemic stroke and strongly encourage early diagnosis and treatment of appropriate patients.11... 

Clinical diagnosis of ischemic stroke causing a measurable neurologic deficit... 

Classical migraine with typical visual symptoms preceding unilateral headache are seldom a differential diagnosis with ischemic stroke. Increased awareness of patients of ischemic symptoms and rapid presentation to emergency rooms with immediate initiation of thrombolytic therapy may chal-... 

Primary ICH is responsible for 10%—15% of all cases of stroke in Western populations and for 20%-30% of strokes among Asian and Black populations (Qureshi et al. 2001). An ICH typically presents with the sudden onset of a focal neurological deficit, which rapidly progresses over minutes to hours. Headache, nausea, vomiting, elevated blood pressure and decreased level of consciousness are more frequently associated with ICH than with ischemic stroke but are by no means pathognomonic. Imaging is therefore mandatory for a proper diagnosis of ICH. Expansion of the hematoma is the most common cause of secondary deterioration within the first few hours after onset (Brott et al. 1997). 

Brott T. and Hacke W. (1998) General treatment of acute ischemic stroke. In Cerebrovascular Disease Pathophysiology, Diagnosis and Management (Ginsberg M. D. and Bogousslavsky J., eds.), Blackwell Science, Malden, pp. 1864— 1878. 

Futrell N (1995). Inflammatory vascular disorders diagnosis and treatment in ischemic stroke. Current Opinions in Neurology 8 55-61... 

Table 9.1. Important clues from the history that may suggest the cause of an ischemic stroke, or that the diagnosis of cerebrovascular disease should be reconsidered...

National Institute for Health and Clinical Excellence (2008). Stroke Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA). Draft Guidance for Consultation. London NICE Petty GW, Brown R-DJ, Whisnant JP et al. (2000). Ischemic stroke subtypes a population-based study of functional outcome, survival, and recurrence. 

Review noncontrast CT with radiologist and order CTA-CTP unless contraindicated. Be prepared to start IV t-PA in the CT suite if the NCCT does not demonstrate a contraindication and the diagnosis of acute ischemic stroke is considered highly likely. Do not delay initiation of t-PA for further imaging (e.g., MRI) unless diagnosis of stroke is unlikely or uncertain and MR is required to confirm appropriateness of treatment... 

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