Stroke diagnosis

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 Draft Guidance for Consultation.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. 

Brain scans are used to study epiiepsy, brain tumors, strokes, Aizheimer s disease, and mentai iiiness. Each of these disorders generates a unique brain activity pattern that differs from the pattern seen in normai brains. Physicians interpret these patterns both for diagnosis and to indicate appropriate treatment. 

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... 

Dijkhuizen RM, Asahi M, Wu O, Rosen BR, Lo EH. Delayed rt-PA treatment in a rat embolic stroke model Diagnosis and prognosis of ischemic injury and hemorrhagic transformation with magnetic resonance imaging. J Cereb Blood Flow Metab. 2001 21 964-971. 

Bray JE, Martin J, Cooper G, Barger B, Bernard S, Bladin C. An interventional study to improve paramedic diagnosis of stroke. Prehosp Emerg Care. 2005 9 297-302. 

INR > 1.7 (PT > 15 if no INR available) with or without chronic oral anticoagulant use Seizure at onset of stroke (This relative contraindication is intended to prevent treatment of patients with a deficit due to postictal Todd s paralysis or with seizure due to some other CNS lesion that precludes thrombolytic therapy. If rapid diagnosis of vascular occlusion can be made, treatment may be given.)... 

Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989 20 1407-1431. 

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. 

Using clinical and emergency CT findings, the TOAST investigators found that their initial designation of subtype of stroke matched the final diagnosis in only 62% of patients. No subtype of stroke was more accurately diagnosed than another by initial assessment. In a series of 100 consecutive stroke patients, the accuracy of the initial classification was reported as 1Q% ... 

It may be especially difficult to confidently establish the diagnosis of the most benign subtype of stroke, small vessel/lacunar stroke, accounting for 10-29% of all... 

Madden KP, Karanjia PN, Adams HP, Clarke WR. Accuracy in initial stroke subtype diagnosis in the TOAST study. Nuerology 1995 45 1975-1979. 

Bogousslavsky J, RegU F, Besson G, Melo TP, Nater B. Early clinical diagnosis of stroke subtype. Cerebrovasc Dis 1993 3 39 t4. 

Toni D, Del Duca R, FiorelU M, Sacchetti ML, Bastianello S, Giubilei F, Martinazzo C, Argentino C. Pure motor hemiparesis and sensorimotor stroke accuracy of very early clinical diagnosis of lacunar strokes. Stroke 1994 25(l) 92-96. 

Shafqat S, Kelly PJ, Furie KL. Holier monitoring in diagnosis of stroke mechanism. Inter Med J 2004 34 305-309. 

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... 

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