Question

cerebrovascular accident : what diagnostics (bloodwork, radiology etc)would you order to rule out the diagnosis?please explain why you are ordering these diagnostics and planning

Answer 1

Cerebro vascular accident is otherwise called as stroke. Health care providers advice a client to underwent the following investigations to confirm the diagnosis and to initiate treatment.

1. Physical examination - physician will perform comprehensive physical examinationand the resultant findings related to stroke includes

-bruit sounds in blood vessels ( carotid arteries) of neck indicating atherosclerosis, a risk factor of stroke

-increased blood pressure, predisposing factor for hemorrhagic stroke

- ophthalmoscopic examination reveals tiny cholesterol crystals or clots in retina which indicates hypertension and hypercholesteremia

- diminished muscle strength, reflexes,vision,speech,and senses

- past and family history of stroke, past and present medical medical history for diabetes, hypertension or other chronic illnesses and use of any medications

2.Blood investigations - clotting time, blood sugar levels, complete blood count, blood culture and sensitivity

Clotting time: altered clotting time leads to clot formation in blood vessels ( especially in cerebral arteries ) that results in ischemic stroke

Blood sugar levels - increased or decreased blood sugar levels changes viscosity of blood that results in clot formation. Fasting blood sugar is used to help diagnosis of DM which is a risk factor of stroke

Blood chemistry- altration in serum electrolytes and normal ions in blood( sodium, potassium, chloride, calcium) can trigger underlying illness.

Blood lipid tests- elevated serum cholesterol, total lipids, LDL cholesterol is a risk factor for stroke

Complete blood count- increase in WBC and other blood cell count indicating presence of infection which triggers antigen antibody complexes and platelet plug formation

Blood culture and sensitivity - presence of infectious micro organism in blood indicates underlying infection

3. Radiological investigations

CTscan- it can identify presence of clot or atherosclerotic plaques in brain skull and spinal cord

MRI scan- indetail visualisation of underlying clot or plaque

Carotid doppler- to identify narrow or atherosclerotic carotid artery

Transcranial doppler - to measure blood flow to arteries of brain

MRA ( magnetic resonance angiogram) - special type of MRI to visualize blood vessels of neck and brain

Cerebral arteriogram- it can detect any narrowed, blocked or malformed( aneurysms, arterio- venous malformations) blood vessels of neck and brain. It gives accurate results than doppler and MRA

Echocardiogram and electrocardiogram - these tests will identify functioning of heart for adequate blood supply to brain. Any underlying abnormalities of cerebral blood flow will be identified