So next let's talk about the
workup for an ischemic stroke.
And we really approach the workup
for a stroke in three phases.
The first is to evaluate
the extent of the stroke.
And we use our MRI scan
or CT to help us determine
what is the extent,
what's the distribution of the stroke,
and how can that tell us what
the etiology or cause would be.
Next, we evaluate the
causes of the stroke.
Strokes come from three areas.
They can come from the heart,
the blood vessels in the neck,
or the blood vessels in the brain.
And we evaluate each of those in
our workup for an acute stroke.
The last is we want to assess
for risk factors of stroke.
And we think about those things that
cause arterial or atherosclerosis,
and some other potential
like sleep apnea,
depression, or others.
First, let's talk about
the workup for a stroke
and evaluating the
extent of the stroke.
The MRI is really the workhorse test
to evaluate the extent of stroke.
It shows us where the
stroke has happened,
and we use the diffusion weighted image
which we're looking at here on the left,
and correlate that with the apparent
diffusion coefficient or ADC map.
These images help us with determining
the location of the stroke
and again that helps to
determine the etiology.
small islands of punctate ischemic infarct
in the deep areas of the brain,
like the basal ganglia, thalamus,
pons or cerebellum or internal capsule
come from long standing hypertension
and we really want to manage
hypertension in those patients.
Large vessel strokes as you can see
here with this large right MCA stroke
tend to come from
In these situations, we see proximal
occlusions like proximal MCA occlusions
which contributed to this patient's
stroke and those large clots
lodged in the proximal vessels and
tend to come from an embolic source.
We can also see a multifocal
pattern, as you see here,
and in this we think about
vasculitis or a showering of emboli
and that can help us to work up
those potential causes of stroke.
So the MRI is very important in
determining the distribution of stroke
understanding its etiology.