hospital admission
(diagnostic procedures)
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SPREAD V Ed. | |
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Acute
stroke: hospital admission (diagnostic procedures) |
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| S 9-1 | A stroke victim should immediately be assessed after hospitalisation, by means of a general examination and a comprehensive neurological and cardiological evaluation. | ||||||||||||||||
| R 9.1 ®GPP |
An early and standardised neurological evaluation is recommended in the setting of a qualitatively adequate management of stroke or TIA. | ||||||||||||||||
| S 9-2 | The aims of an early clinical evaluation
are:
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| R 9.2 Grade D |
It is recommended that the neurological assessment is performed by a neurologist or alternatively by a physician expert in stroke evaluation and care. | ||||||||||||||||
| R 9.3 Grade D |
The clinical definition of the involved vascular territory is recommended for its practical implications, including the diagnostic work up, the correlation with the results of neuroimaging, the identification of the mechanism, the prognostic assessment and the therapeutic decisions. | ||||||||||||||||
| R 9.4 Grade D |
On admission to hospital of a suspected stroke victim the following blood exams are recommended: complete blood count including platelets, serum glucose, serum electrolytes, creatinine, total plasma proteins, bilirubin, transaminases, coagulation tests. | ||||||||||||||||
| Re 9.5 Grade D |
 In patients with acute stroke, the lumbar puncture is
recommended only when a subarachnoid haemorrhage is clinically suspected
and the CT scan is negative. |
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| S 9-3 | The chest radiography is useful early after the hospital admission for the evaluation of heart failure, aspiration pneumonia or other possible cardiological or pulmonary early complications. | ||||||||||||||||
| R 9.6 Grade D |
The electrocardiogram is recommended in all suspected stroke victims who are admitted to an Emergency Room. | ||||||||||||||||
| R 9.7 Grade D |
A non-contrast CT scan
is recommended as soon as possible in the emergency care:
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| S 9-4 | The early hypodensity sign should suggest a review of the anamnesis, possibly with the participation of other witnesses (relatives or others) able to give as accurate information as possible on the true onset time of the event. | ||||||||||||||||
| S 9-5 | In the emergency phase, MRI does not provide more information than CT scan. The diffusion- and perfusion-weighted sequences may be helpful for a more accurate pathogenic and prognostic evaluation and for a better selection of patients who are candidates to i.v. or i.a. thrombolysis. | ||||||||||||||||
| S 9-6 | When deciding to acquire new MRI machines, it should be taken into account the possibility to implement MRI diffusion, perfusion and spectroscopy techniques. | ||||||||||||||||
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R 9.8 Grade D |
Digital subtraction angiography is recommended in the acute stroke only if pre-procedural to an intra-arterial thrombolytic approach. | ||||||||||||||||
| S 9-7 | After the acute phase, the neuroimaging control may be performed by either CT scan or MRI. The MRI is more accurate in case of lacunar or brainstem infarct. | ||||||||||||||||
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R 9.9 Grade D |
The repetition of non-contrast CT scan is suggested within 48 h and anyhow not later than 7 days from stroke onset. It is particularly recommended when stroke is severe or progressing, or the diagnosis of stroke is uncertain. | ||||||||||||||||
| S 9-8 | Soon after hospitalisation, ultrasound studies of extra- and intra-cranial vessels are useful for an early definition of pathogenic subtypes, of thromboembolic risk and for urgent therapeutic decisions. The same applies to transthoracic and transoesophageal echocardiography, however, their execution in this phase should be decided based on local facilities and following the indication in the specific case. In a subsequent phase, such studies have to be performed following the indications given in chapter 5. | ||||||||||||||||
| S 9-9 | Non-invasive trans-cranial Doppler (TCD), angio MRI and angio CT studies that evaluate the patency of cerebral vessels are helpful for establishing the site and severity of the arterial occlusion and for an adequate selection of potential candidates to thrombolysis (especially for the intra-arterial approach). At present, however, their use appears restricted to high-level centres. |
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