Managing CVA in ED Learning Objectives Is it a stroke? Diagnosis ...
Managing CVA in ED Learning Objectives Is it a stroke? Diagnosis ...
Managing CVA in ED Learning Objectives Is it a stroke? Diagnosis ...
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CT Scan (w<strong>it</strong>h contrast) - CTA<br />
• 98% sens<strong>it</strong>iv<strong>it</strong>y for large vessel occlusion<br />
• Shows thicken<strong>in</strong>g/calcification vessel wall<br />
• Better sens<strong>it</strong>iv<strong>it</strong>y for ischemia<br />
• Adds approx. 10-15 m<strong>in</strong>s. to study<br />
• Includ<strong>in</strong>g neck to aortic arch def<strong>in</strong>es<br />
important vascular anatomy<br />
Diffusion-weighted MRI<br />
• 94% sens<strong>it</strong>iv<strong>it</strong>y/96% specific<strong>it</strong>y <strong>in</strong> early<br />
ischemic <strong>stroke</strong><br />
• More accurate from lacunar/bra<strong>in</strong>stem<br />
<strong>in</strong>farcts<br />
• Changes progress <strong>in</strong> a fashion that allows<br />
tim<strong>in</strong>g of <strong>stroke</strong> onset (wake up <strong>stroke</strong>)<br />
Lim<strong>it</strong>ations MRI<br />
• Take a long time<br />
• Tough to mon<strong>it</strong>or patients<br />
• Not widely available for emergencies<br />
• Not as sens<strong>it</strong>ive for detect<strong>in</strong>g blood<br />
Review Imag<strong>in</strong>g Options<br />
• CT – Still the gold standard; better for<br />
blood<br />
• Consider CTA if acute, large <strong>CVA</strong> and<br />
consider<strong>in</strong>g aggressive <strong>in</strong>tervention and<br />
readily available<br />
• MRI – bra<strong>in</strong>stem <strong>stroke</strong>s and “wake up”<br />
<strong>stroke</strong>s; better posterior circulation<br />
<strong>CVA</strong> Patient<br />
Sub-acute <strong>CVA</strong> management<br />
Acute Symptoms<br />
< 5 hrs.<br />
Or “stutter<strong>in</strong>g”<br />
Assess/address<br />
complications<br />
Determ<strong>in</strong>e<br />
NIHSS Score<br />
Subacute<br />
>5hrs<br />
• Etiology<br />
• Acute treatment<br />
• Hosp<strong>it</strong>alize or not<br />
Imag<strong>in</strong>g<br />
Subacute <strong>CVA</strong><br />
4
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