Echocardiography: transthoracic, transesophageal 24-hour ambulatory cardiac monitoring Cardiac nuclear scanning Blood Tests
Vascular imaging can be divided into noninvasive and invasive studies. Four commonly used noninvasive tests are Duplex scans (B-mode and Doppler combined), transcranial Doppler ultrasonography (TCD), MRA, and CTA. Duplex scans show an accurate image of the extracranial carotid and subclavian arteries. TCD is useful for the evaluation of the intracranial cerebral arteries by measuring flow velocities and directions. MRA and CTA are also noninvasive methods for the evaluation of intracranial and extracranial large arteries. Combined use of these noninvasive tests is usually adequate for evaluation of most stroke patients. MR venography is now a very useful diagnostic tool for showing cerebral venous sinus thrombosis and has largely replaced invasive conventional cerebral angiography. When there is any suspicion of significant vascular lesions such as severe intra- or extracranial stenosis, aneurysm, arteriovenous malformation (AVM), or vasculitides, standard femoral artery catheterization and angiography are usually done to further define and characterize the
Figure 45-3 (Figure Not Available) Internal carotid artery atherosclerotic lesions: (a) plaque; (b) plaque with platelet-fibrin emboli; (c) plaque with occlusive thrombus; (d) recent ischemic cerebral infarct due to internal carotid artery o<CAdapCecC from Caplan LR: Stroke. Clinical Approach. Boston, Butterworth-Heineman, 1993.)
lesions and, when possible, to intervene to treat vascular lesions at the same time. y Important laboratory tests for stroke patients are listed in Table.,.45-1 .
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