From the Guidelines
For a patient with stroke-like symptoms, essential laboratory tests include a complete blood count (CBC), comprehensive metabolic panel, coagulation studies (PT/INR, PTT), blood glucose, and cardiac biomarkers, but a D-dimer test is not routinely indicated unless pulmonary embolism or deep vein thrombosis is suspected 1. The primary goal in managing a patient with stroke-like symptoms is to rapidly assess and initiate time-sensitive treatments, with a focus on minimizing morbidity, mortality, and improving quality of life.
- Key laboratory tests to order include:
- Complete blood count (CBC)
- Comprehensive metabolic panel
- Coagulation studies (PT/INR, PTT)
- Blood glucose
- Cardiac biomarkers
- Additional tests that may be valuable include hemoglobin A1c, lipid panel, and toxicology screening, as recommended by the American Heart Association/American Stroke Association guidelines 1. The most critical aspect of stroke management is rapid assessment, as time-sensitive treatments like thrombolysis with tPA must be administered within a narrow therapeutic window (typically within 4.5 hours of symptom onset) 1.
- Laboratory testing should not delay imaging or treatment decisions in acute stroke presentations, as the "time is brain" principle emphasizes that neurological damage progresses with each minute of delayed intervention 1. In terms of imaging, a non-contrast head CT is the primary study to rule out hemorrhage, followed by CT angiography or MRI depending on the clinical scenario.
- The choice of imaging modality depends on the specific clinical presentation and the suspected cause of the stroke-like symptoms.
From the Research
Laboratory Tests for Stroke-Like Symptoms
The following laboratory tests are recommended for patients presenting with stroke-like symptoms:
- Complete blood count with platelet count
- Prothrombin time
- International Normalized Ratio
- Partial thromboplastin time
- Electrolyte and glucose levels 2
Imaging Studies
Computed tomographic scanning of the head should be performed immediately to ensure that there is no evidence of brain hemorrhage or mass 2
D-Dimer Test
There is no mention of the D-dimer test being necessary for patients with stroke-like symptoms in the provided studies 2, 3
Initial Evaluation
Patients who arrive at the emergency department within 180 minutes of symptom onset should undergo an expedited history and physical examination, as well as selected laboratory tests, to determine if they are candidates for thrombolytic therapy 2