Saturday, May 14, 2011

Laboratory tests in stroke patients

Laboratory tests in stroke patients Laboratory tests in patients with stroke include: Calculate the complete peripheral blood: blood dyscrasias, polycythemia, thrombocytopenia or thrombocytosis or infection as a risk factor for stroke.
prothrombin time, partial prothrombin time: addressed to patients with antiphospholipid antibodies (lengthwise partial prothrombin time).
Analysis of urine: hematuria occurred in subacute bacterial endocarditis (SBE) with ischemic stroke due to embolism.
sedimentation rate (ESR) LEDs indicate a possible increase in vasculitis, hiperviskositas or (SBE) as a cause of stroke.
blood chemistry: elevated levels of glucose, cholesterol or triglycerides in the blood.
chest X-rays: widening the size of the heart as a source of emboli in a stroke or hypertension due to long; to find an unexpected ferocity.
Electrocardiogram: to indicate a cardiac arrhythmia, new myocardial infarction, or dilation of the left atrium.
Computed Tomography (CT scan).

Computed Tomography (CT scan) is useful in distinguishing haemorrhagic stroke (intracerebral or subarachnoid) with stroke without hemorrhage / ischemia (thrombosis or embolism). The presence of blood on the new bleeding resulting in a region with increased density; otherwise an infarct resulting in a region with reduced density. In addition, CT-scan can help determine the location and size abnormalities, such as the vascularization, superficial or deep, small or large.

1. CT-scan was positive in intracerebral hemorrhage (with increased density) and often showed inter-hemisphere blood or bleeding in the brain to the bleeding subarakhnoidea parenkhim. These changes seen in the first hours after the onset of stroke symptoms. With more advanced CT again, some patients with clinical diagnosis of thrombosis can be found in the bleeding intraparenkhimal.

2. CT-scan is positive in most cases of cerebral infarction (decreased density), but peruhahan these changes can only be seen in 24-48 hours after the onset of stroke symptoms. By penyengatan of contrast, infarct can mimic a tumor but penyengatan against the contrast of the cerebral infarction is generally not associated with significant mass effect as happened in tumors. In a few instances. maybe there is mass effect with infarction, which raises the question of whether not a tumor, in which case it is with MRI, CT scan and serial clinical observations may clarify the diagnosis.

3. A common herdarah infarction secondary to embolism are great. In this case an increase in density on CT-scan. Provision of anticoagulants should be delayed if there is bleeding associated with embolic infarction.

4. Bleeding in the brain stem may be seen on CT scans, but brain stem infarction is usually not.

5. CT-scan to identify intracranial mass shift that requires medical treatment and operative aggressively to control the cerebral edema that occurs.

6. A subdural hematoma can be recognized on CT-scan with the shift of intracranial mass, partial disappearance of the lateral ventricles or sulcus-sulcus, and changes in density (depending on age of lesion) on perrnukaan brain.

7. Brain tumors can be identified on CT-scan with a typical density patterns, penyengatan of contrast, and mass effect. In a small percentage of brain tumors is clinically resemble a stroke.

MRI (Magnetic Resonance Imaging)
MRI plays an important role in the diagnosis of a stroke because:
1. MRI can sometimes show the existence of cerebral ischemia at an early stage, before it can be seen on CT-scan and often when the CT-scan remained negative.
2. MRI can often show the existence of infarction in the brain stem, cerebellum, or temporal lobes are not visible on CT-scan.
3. The ability of MRI in the search for deep-vein thrombosis as a cause of infarction is better than CT-scan.
4. MRI is more sensitive in finding small infarction (lakuner). CT-scan is still better dihanding MRI in the acute phase of stroke when the main goal to find the bleeding and there is a problem in terms of cooperation with the patient.
5. Penyengatan contrast in MRI is useful in determining the possibility of an infarct age and look for a tumor or AVM as a cause of stroke.

Note: SPECT (single photon emission computed tomography) can localize ischemia within a few hours after a stroke.

Arteriography, both worked with conventional and digital techniques, is intended to (a) identifying a lesion that can be corrected with surgery such as intracranial aneurysms and AVM, carotid artery stenosis, and carotid artery plaque is ulcerated, (b) help confirm the diagnosis, and (c) confirm the diagnosis before giving antikoagulansia done. In planning an arteriography, is clinically important to determine which systems are involved in stroke, carotid system or the system vertebrobasiler. Where possible, angiography is done with catheterization technique by an experienced radiologist.

Electroencephalography (EEG)
Electroencephalography (EEG) can help determine the localization of cortical dysfunction, and occasionally in the thalamus lesions. EEG can be abnormal in the first hours after a stroke, although the CT-scan was normal. EEG will usually be normal in the area of stroke in the posterior circulation or lacunar stroke and abnormal in the anterior circulation stroke or embolism region.
EEG is usually abnormal in stroke large blood vessels or embolism.

EEG is an important thing to do when a suspected epileptic activity. Weakness after a stroke may be a part of the post-attack epilesi (Todd paralysis).

Lumbar puncture
When the cerebrospinal fluid (CSF) containing blood (erythrocytes) 1000) and the pressure increased (200 mmH2O), lumbar puncture support the existence of a hemorrhage. Please note that normal CSF pressure and is not found in CSF cells can occur in 10% of intracerebral hemorrhage. All subarachnoid hemorrhage showed significant bleeding in CSS, usually containing erythrocytes 25,000.
Lumbar puncture with the content of erythrocytes 50-500 in the CSS to direct suspicion on cerebral embolism, and appeared to CSS clear in most of embolism.

In cerebral thrombosis and lacunar stroke was not found in CSS cells. Sometimes it seems the leucocytes in the CSF after the attacks of thrombosis or bleeding. Erythrocytes in large numbers (10000-20000) is sometimes seen in myocardial blood after an attack of cerebral embolism. After further development in the presence of CT, lumbar puncture is rarely done anymore in order to evaluate stroke patients lumbar puncture is done when:
Suspicion of central nervous system infection.
The possibility of enforcement of the diagnosis of sub-arachnoid haemorrhage. CT scans can produce false negative in 50-10% of patients with subarachnoid hemorrhage,
The possibility of enforcement of the diagnosis of intra-cerebral hemorrhage, but did not allow performed CT-scan, and found no signs of increased intracranial pressure.
Before you start 'giving antikoagulansia, in order to rule out any bleeding if it is not possible to do CT scan.
suspicion of arteritis.
Diagnosis of patients is unclear.

Source: fkunhas       

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