Guidelines for Management of Ischaemic Stroke 2008 - ESO

ESO-Guidelines for Management of Ischaemic Stroke 2008
Patients with widely varying brain pathology may present with transient neurological
deficits indistinguishable from TIA. CT reliably detects some of these pathologies
(e.g. intracerebral haemorrhage, subdural haematoma, tumours) [129], but others
(e.g. multiple sclerosis, encephalitis, hypoxic brain damage, etc.) are better identified
on MRI, while others (e.g. acute metabolic disturbances) are not visible at all.
Intracranial haemorrhage is a rare cause of TIA.
Between 20-50% of patients with TIAs may have acute ischaemic lesions on DWI
[144, 188, 189]. These patients are at increased risk of early recurrent disabling
stroke [189]. However, there is currently no evidence that DWI provides better stroke
prediction than clinical risk scores [190]. The risk of recurrent disabling stroke is also
increased in patients with TIA and an infarct on CT [191].
The ability of DWI to identify very small ischaemic lesions may be particularly helpful
in patients presenting late or in patients with mild non-disabling stroke, in whom the
diagnosis may be difficult to establish on clinical grounds [130]. T2*-MRI is the only
reliable method to identify haemorrhages after the acute phase, when blood is no
longer visible on CT [143].
Other diagnostic tests
Recommendations
In patients with acute stroke and TIA, early clinical evaluation, including
physiological parameters and routine blood tests, is recommended (Class I,
Level A)
For all stroke and TIA patients, a sequence of blood tests is recommended (Table
3, Table 5)
It is recommended that all acute stroke and TIA patients should have a 12-lead
ECG. In addition continuous ECG recording is recommended for ischaemic stroke
and TIA patients (Class I, Level A)
- 26 -