STROKE (BRAIN ATTACK) - William A. Tosches, MD; Michael Previti, MD9

STROKE (BRAIN ATTACK) - William A. Tosches, MD; Michael Previti, MD

TESTS

· Duplex carotid ultrasonography

· Cerebral angiography

· ECG

· Transthoracic ECG; if normal and a cardiac source is suspected, follow-up with transesophageal ECG.

· Holter monitoring

· EEG for suspected seizure

· Prothrombin time (PT) and partial thromboplastin time (PTT)

  - Coumadin prolongs PT.

· Antiphospholipid antibodies

· Cardiac enzymes

Imaging

Acute phase

· Multimodal CT of head

· MRI scan of brain with diffusion weighted imaging (DWI) remains the most powerful and accurate method for stroke identification.

· Arterial occlusions are seen with CTA as well as with MRA.

· Both CTA and MRA are highly reliable, noninvasive methods to verify the results of thrombolytic therapy.

· Quantitative CT perfusion and DWI/PWI (perfusion-weighted imaging) can rapidly provide functional information about brain perfusion and thus guide antithrombotic and neuroprotective strategies.

· Quantitative CTP is limited to a single slab of tissue per bolus, whereas MRI can provide whole-brain cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT).

· The goal of perfusion imaging is to reliably identify and distinguish brain tissue that is ischemic and will develop infarction without a specific intervention from brain tissue that is already damaged and cannot escape infarction.