17. Diagnostic procedures in cerebrovascular disorders

Question 1

Stroke protocol

Answer 1

1. ABCDE
2. Blood sample: especially glucose + INR (hypoglycemia can mimic stroke)
3. GCS/NIHSS
4. ECG
5. Imaging of brain parenchyma: non-contrast CT/MRI – differentiate ischemic vs hemorrhagic
6. Imaging of vessels: CT/MRI-angiography – if not available = US
7. Thrombolysis: if within ther. window and no CI

Question 2

Define cerebrovascular disorders

Answer 2

An area in the bain is temporarily/permanently affected by ischemia or hemorrhage, and one or more of the cerebral blood vessels are involved

Question 2

Contraindication of thrombolysis

Answer 2

• Large artery occlusion in MCA
• Surgery in the last 2 weeks
• Previous intracranial hemorrhage
• INR above 1,7
• Severe thrombocytopenia

Question 3

Stroke types

Answer 3

Ischemic stroke (85%)
- Thrombotic
- Embolic
- Hemodynamic
- Lacunar

Hemorrhagic strok (15%)
- Subarachnoid
- Intracerebral

Question 4

Diagnostic procedures of all patients with cerebrovascular disorders

Answer 4

• Neuroimaging (CT or MRI)
• ECG
• Lab tests: CBC, INR, serum electrolytes, blood glucose, CRP, hepatic and renal function

Question 5

Mandatory steps before thrombolysis

Answer 5

• Check glucose: hypoglycemia can mimic stroke
• Check for coagulopathies (INR): contraindication for thrombolysis
• Blood pressure: hypertension increase hemorrhagic risk of thrombolysis

Question 6

Diagnsotic considerations in cerebrovascular diseases

Answer 6

• Presence of clinical signs
• Hemorrhagic vs. ischemic (CT, MRI)
• Pathomechanism (thrombotic, embolic, hemodynamic, small vessel disease)
• Brain region
• Duration of signs
• Supplying vessel
• Etiology

Question 7

Possible etiologies of cerebrovascular disease

Answer 7

• Large vessel atherosclerosis
• Small vessel occlusion
• Cardioembolism
• Unknown cause