In patient imaging of CVA

[winterallsummer]

We all know that CVA needs non contrast head CT to start with and an MRI later on. As far as angiography and carotid imaging, what is everyone using (assume the pt had non con head CT only then admitted to you)? MRI brain and also MRA head/neck? Anyone using CTA head/neck before the MRI? Any institutions still relying heavily on dopplers in typical cases? Any anectodal or referenced data appreciated. Also anyone jumping right to TEE?

[winterallsummer]

Let me add that one is assuming endovascular interventions are available.

[charlottew]

noncontrast head CT in the ED, and also stat for any acute changes in neuro exam.

 

CTA of head/neck to look for aneurysms/bleeds (HA on presentation, or hemorrhage on CT), or to map ischemic areas or look for occlusions/stenosis

 

MRI later on to map embolic stroke territories. MRV if venous sinus thrombosis is suspected.

 

CT's at our institution get done a lot faster than MRI's, so we rely on them more.

 

We use transcranial dopplers to monitor subarachnoids, 3x/week while they're in the spasm window (3wks of nimodipine)

 

We have neurosurg and neuro IR available, they're consulted as needed and intervene as necessary.

 

If it's suspected embolic, workup includes lipid panel, HgbA1C, and TTE. TEE only if we need a better look at the atria/valves for some reason.

 

We pretty much follow standard guidelines for neurocritical care, I believe the neurocritical care society is http://www.neurocriticalcare.org/

 

Disclaimer: I'm relatively new to all this (<1 year on the job), I work at a teaching hospital that's a regional stroke center, in the neurocritical care unit.