From the Guidelines
For stroke-like symptoms, a D-dimer test is not typically part of the initial evaluation, and instead, you should order a non-contrast head CT scan immediately to rule out hemorrhagic stroke, followed by a CT angiogram or MRI if ischemic stroke is suspected. The initial evaluation of a patient with suspected stroke should focus on rapid imaging to determine the type of stroke and the potential for time-sensitive interventions like thrombolysis with tPA or mechanical thrombectomy 1.
Key Tests in Acute Stroke Evaluation
- Non-contrast head CT scan to rule out hemorrhagic stroke
- CT angiogram or MRI if ischemic stroke is suspected
- Complete blood count
- Comprehensive metabolic panel
- Coagulation studies (PT/INR, PTT)
- Blood glucose
- ECG
Time is critical in stroke management, and these tests should be obtained rapidly while simultaneously performing a thorough neurological examination using a standardized stroke scale like the NIH Stroke Scale 1. D-dimer testing is more relevant for suspected venous thromboembolism (DVT or pulmonary embolism) rather than arterial occlusions that cause strokes. The focus in acute stroke is on rapid imaging to determine if the patient is a candidate for time-sensitive interventions like thrombolysis with tPA (if within 4.5 hours of symptom onset) or mechanical thrombectomy. Remember that "time is brain" - approximately 1.9 million neurons die each minute during an acute ischemic stroke, making immediate evaluation and treatment essential 1.
Additional Considerations
- Cardiac tests, including a 12-lead ECG, should be performed to identify potential cardiac causes of stroke or cardiac arrhythmias that may require urgent treatment 1.
- Monitoring for serious cardiac arrhythmias should be conducted routinely after an acute cerebrovascular event.
- Examination of the cerebrospinal fluid may be indicated if subarachnoid hemorrhage is suspected and a CT scan does not demonstrate blood.
- Electroencephalography may be helpful for evaluating patients in whom seizures are suspected as the cause of the neurological deficits or in whom seizures could have been a complication of the stroke.
From the Research
Stroke-like Symptoms and Diagnostic Tests
When a patient presents with stroke-like symptoms, it is crucial to determine the cause of the symptoms to provide appropriate treatment. The following diagnostic tests may be ordered:
- Computed Tomography (CT) scan to rule out hemorrhagic stroke 2, 3
- CT angiography to identify underlying vascular etiology 2
- Non-contrast CT scan to predict hemorrhagic transformation risk in stroke patients undergoing revascularization 4
Role of D-Dimer in Stroke Diagnosis
There is no evidence to suggest that D-Dimer is a necessary test for stroke-like symptoms. The studies provided focus on the use of imaging modalities such as CT scans and CT angiography to diagnose and manage stroke patients 2, 4, 5, 6, 3.
Imaging Modalities in Stroke Diagnosis
Imaging modalities play a crucial role in the diagnosis and management of stroke patients. The following points highlight the importance of imaging modalities:
- CT angiography can identify underlying vascular etiology in hemorrhagic stroke patients 2
- Non-contrast CT scan can predict hemorrhagic transformation risk in stroke patients undergoing revascularization 4
- Post-thrombectomy CT scans can be challenging to interpret, and advanced imaging modalities may be warranted for challenging clinical cases 6