How do you work up an ischemic CVA? A) Initial Evaluation • ABCs • IV access, monitor • Finger glucose • Medication administration review • Physical exam (complete neuro, NIHSS) • Non-contrast CT (NCCT) head (r/o hemorrhage and other mimics) B) Evaluate ischemic CVA (core, penumbra) • Can be visualized on a NCCT or • MRI brain w/o contrast (most sn/sp) or • CTA +/- CTP (if available) C) Evaluate underlying cause & classify (TOAST) Intracranial/Extracranial: • Detected on NCCT vs MRI w/o contrast • Carotid US Cardioembolic: • ECG + 24 hr telemetry monitoring • TTE +/- TEE (high Afib suspicion) • +/- bubble study (r/o PFO if <60 y) • +/- loop v Holter (r/o Afib) Other: • CBC, coags • +/- hypercoagulable w/u • +/- Cerebral angiography • +/- Vit B12, TSH, RPR Cryptogenic - Defined if 1) CT/MRI-confirmed non-lacunar CVA 2) No major-risk embolic source 3) Relevant vasculature w/o > 50% stenosis 4) Ruled out other causes - Dr. Uday Gulati, DO @udaygulati #ischemic #CVA #stroke #workup #diagnosis #checklist #neurology
