What is the gold standard for stroke diagnosis?

In the first 3 hours after a suspected cerebrovascular accident (CVA), noncontrast head computerized tomography (CT) is the gold standard for diagnosis of acute hemorrhagic stroke (SOR: C, based on expert panel consensus). However, the sensitivity for hemorrhage declines steeply 8 to 10 days after the event.

What is hyperacute stroke?

Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the “hyperacute stroke patient.” This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when …

What imaging is best for stroke?

Currently in the United States, noncontrast computed tomography (CT) remains the primary imaging modality for the initial evaluation of patients with suspected stroke (Figure 1).

How can you tell the difference between ischemic and hemorrhagic stroke?

An ischemic stroke occurs when a blood vessel supplying the brain becomes blocked, as by a clot. A hemorrhagic stroke occurs when a blood vessel bursts, leaking blood into the brain.

Are hyperacute infarcts seen on CT scan?

Although older literature positions have suggested that CT was negative during the first 48 hours, modern CT technology can demonstrate positive findings even in the first 3 hours of onset.

Is CT scan or MRI better for stroke?

“While CT scans are currently the standard test used to diagnose stroke, the Academy’s guideline found that MRI scans are better at detecting ischemic stroke damage compared to CT scans,” said lead guideline author Peter Schellinger, MD, with the Johannes Wesling Clinical Center in Minden, Germany.

Is a CT scan better with or without contrast?

CT of the brain can be done with or without contrast, but it is often not needed. In general, it is preferred that the choice of contrast or no contrast be left up to the discretion of the imaging physician.

Can diffusion-weighted imaging identify ischemic stroke early?

Diffusion-weighted imaging (DWI) has a high diagnostic accuracy for identifying ischemic stroke, even in a very early stage, and recombinant tissue plasminogen activator (rtPA) thrombolysis is so far the most efficient treatment for acute ischemic stroke within the 4.5-h window from symptom onset [1].

What is the first-line imaging modality after a stroke?

NCCT is the first-line imaging modality in most centers as the patient admitted and stabilized in the emergency room. It is performing to exclude hemorrhagic stroke and intracranial hemorrhage. The next imaging is CTP and CTA.

What is a non-contrast CT scan for stroke?

The non-contrast CT, CTA, and CTP are the backbone of ischemic “code-stroke” imaging in many stroke centers.[32] In most ischemic stroke guidelines, there is a general trend to extend the window of treatment for the tissue at risk (ischemic penumbra) up to 24 hours after the insult.

What is acute ischemic stroke?

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide.