The Preferred Diagnostic Tests for Acute Cerebrovascular Disease

When a patient experiences symptoms of acute cerebrovascular disease, it is crucial to perform a series of hematological tests within the first 4.5 hours of symptom onset. These include a complete blood count (CBC), liver and kidney function tests, electrolyte levels, coagulation profile, and cardiac biomarkers. Among these, blood glucose levels are particularly significant and can be rapidly assessed using a point-of-care glucose meter. These initial assessments help rule out other potential causes and guide appropriate treatment decisions.

Essential Imaging and Cardiac Evaluations

In addition to blood tests, an electrocardiogram (ECG) and non-contrast computed tomography (CT) scan of the brain are essential diagnostic tools during the early phase of an acute ischemic stroke. These tests help confirm the diagnosis, exclude hemorrhagic stroke, and determine eligibility for thrombolytic therapy. Rapid assessment through these modalities is vital, as timely intervention significantly improves patient outcomes.

Time-Sensitive Treatment Options

The primary treatment for ultra-acute ischemic stroke is intravenous thrombolysis, which must be administered within a narrow time window. Therefore, expediting the evaluation process—including blood glucose testing, ECG, and brain imaging—is critical. Once test results are available, immediate consultation with a stroke specialist is strongly recommended to proceed with the most appropriate intervention.

Special Considerations for Anticoagulated Patients

For patients who are on anticoagulant therapy, such as low molecular weight heparin, or those with known coagulopathy, treatment decisions must await the results of coagulation studies. These findings will determine whether thrombolytic therapy is safe or if alternative management strategies should be considered.

Advanced Imaging for Extended Time Windows

In cases where the onset of symptoms exceeds 4.5 hours or when patients present with severe neurological deficits, mechanical thrombectomy may be an option. For such scenarios, advanced imaging techniques like brain MRI and magnetic resonance angiography (MRA) are recommended. In hospitals equipped with the necessary technology, cerebral CT angiography (CTA) and CT perfusion scans can provide valuable insights into the location and extent of the ischemia, guiding further intervention.