The initial goal of imaging in the evaluation of acute stroke is to determine whether a hemorrhage is present. Noncontrast CT of the head is quick and accurate in identifying most cases of intracranial hemorrhage.3 If hemorrhage is identified, aggressive blood pressure control and reversal of anticoagulation take precedence over more detailed brain and angiographic imaging. If no hemorrhage is present, further imaging is warranted.3 Angiographic imaging (CT angiogram or MRA) is useful in screening for large vessel pathology, and brain magnetic resonance imaging provides high-resolution images that are sensitive to chronic vascular lesions. Both of these studies would be appropriate if CT of the head shows no hemorrhage.
- CT of the head without contrast.
3. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists [published errata appear in Stroke 2007;38:e38 and 2007;38:e96]. Stroke 2007;38:1655–711.
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