AANN Comprehensive Review for Stroke Nursing, 2nd Edition, Ch. 4 Stroke Diagnostics: Digital Version-Stroke Chapter 4

Stroke Chapter 4

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Stroke diagnosis combines laboratory, imaging, cardiac, and other studies to distinguish ischemic stroke from hemorrhage, identify stroke mimics and causes, and guide treatment. <strong>Do not delay brain CT or urgent stroke treatment to complete routine laboratory tests.</strong> Blood glucose is the only laboratory test required before IV alteplase; abnormal glucose can mimic stroke and should be treated. Other tests assess electrolytes, renal function, oxygenation, cardiac injury, blood counts, coagulation, and possible toxic or hypercoagulable causes. Coagulation tests are especially urgent when anticoagulant use or hemorrhage is suspected. Renal function and contrast allergies matter before contrast-enhanced imaging, but should not unnecessarily postpone urgent intervention.

Noncontrast head CT is the rapid first-line study for suspected stroke and the standard initial test for detecting intracranial bleeding. CT angiography identifies vessel occlusions and vascular lesions; CT perfusion helps distinguish potentially salvageable penumbra from infarct core and can guide thrombectomy selection in later treatment windows. MRI, particularly diffusion-weighted imaging, detects ischemia that may be missed on CT and helps assess posterior fossa or brainstem lesions, but its longer acquisition time and device restrictions may limit emergency use. Cerebral digital subtraction angiography is the gold standard for detailed vascular assessment and can also enable treatment, such as thrombectomy, aneurysm coiling, or vasospasm therapy.

Additional studies include transcranial Doppler for vasospasm monitoring after subarachnoid hemorrhage; echocardiography, ECG, and carotid ultrasound to investigate cardiac or arterial sources; EEG when seizure is suspected; and lumbar puncture when subarachnoid hemorrhage remains suspected despite a negative CT.

Nursing care includes explaining procedures, documenting baseline and follow-up neurological status and vital signs, screening for contrast risks and MRI-incompatible devices, and monitoring for complications. After angiography, closely assess the access site, bleeding, distal pulses, and neurovascular status. After lumbar puncture, monitor for headache or CSF leakage.

Keywords

stroke diagnosis

noncontrast head CT

ischemic stroke

hemorrhage

blood glucose

CT angiography

CT perfusion

diffusion-weighted MRI

cerebral angiography

lumbar puncture