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CDHB

Investigations for Stroke

• Include:
  • CBC + diff (polycythaemia, thrombocytosis).
  • CRP or ESR (arteritis).
  • Na, K, creatinine.
  • Glucose.
  • HbA1c.
  • Lipids.
  • ECG.
  • CT head scan.

    Note: Cerebral haemorrhage is not distinguishable from cerebral infarction on clinical grounds alone. CT distinguishes between haemorrhage and infarction, defines the location of the lesion and may define the nature of the underlying cause.

• The following investigations may also be appropriate:
  • Coagulation profile (all patients with haemorrhage).
  • Duplex carotid ultrasonography (minor ischaemic stroke/TIA, ICA territory, possible surgical candidate). See Transient Ischaemic Attacks.
  • MRI brain, including diffusion-weighted imaging.
    • Particularly helpful when diagnosis is uncertain, and for unusual stroke syndromes/younger patients e.g., carotid or vertebral artery dissection, cerebral venous sinus thrombosis.
    • Consider Neurological consultation.
  • Thrombophilia screen, lupus anticoagulant, anticardiolipin antibodies, homocysteine (generally younger patients only).
  • Echocardiogram (transthoracic or transoesophageal; particularly if recent myocardial infarction, dilated cardiomyopathy, or if mitral valve disease or LV aneurysm suspected, or for younger patients (usually <50 years old) with no other cause identified (?patent foramen ovale - transoesophageal echo required).
  • Syphilis serology.
  • ANA.
  • Angiography - MRA, CTA or DSA (particularly for patients with ICH, but may not be required for deep hypertensive haemorrhages). MRV or CTV for suspected cerebral venous sinus thrombosis.
• CXR is not a routine investigation for stroke. Request as clinically indicated.

Topic Code: 1505