BMJ  2004;328:655-656 (20 March), doi:10.1136/bmj.328.7441.655

Editorial

Diagnosis of stroke on neuroimaging

"Scan all immediately" strategy improves outcomes and reduces costs

The first 150 words of the full text of this article appear below.

Stroke is the clinical syndrome of rapid onset of focal, or sometimes global, cerebral deficit with a vascular cause, lasting more than 24 hours or leading to death.1 Eighty per cent of strokes are ischaemic, 15% are due to intracerebral haemorrhage, and 5% to subarachnoid haemorrhage. Correct diagnosis is important because treatments for ischaemic stroke2 may be contraindicated in intracerebral haemorrhage.3 The diagnosis requires imaging of the brain.4 But which imaging—computed tomography or magnetic resonance—how quickly should it be done, should this include imaging cerebral blood flow, and what is the most cost effective approach?

The average general hospital (catchment population 250 000-500 000) will see two to three patients with stroke per day. Many patients have poor airway control, are confused, or are unable to communicate. Routine imaging for most patients must therefore be quick (speed is of the essence for patients, salvaging their brain, and for the radiology . . . [Full text of this article]

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J M Wardlaw, professor of neuroradiology

(jmw@skull.dcn.ed.ac.uk)

A J Farrall, neuroradiology fellow

Division of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU


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  • Wardlaw, J. M., Farrall, A. J., Perry, D., von Kummer, R., Mielke, O., Moulin, T., Ciccone, A., Hill, M., for the Acute Cerebral CT Evaluation of Stroke Stu, (2007). Factors Influencing the Detection of Early CT Signs of Cerebral Ischemia: An Internet-Based, International Multiobserver Study. Stroke 38: 1250-1256 [Abstract] [Full text]  
  • Tan, P L, King, D, Durkin, C J, Meagher, T M, Briley, D (2006). Diffusion weighted magnetic resonance imaging for acute stroke: practical and popular.. Postgrad. Med. J. 82: 289-292 [Abstract] [Full text]  
  • Immink, R. V., van Montfrans, G. A., Stam, J., Karemaker, J. M., Diamant, M., van Lieshout, J. J. (2005). Dynamic Cerebral Autoregulation in Acute Lacunar and Middle Cerebral Artery Territory Ischemic Stroke. Stroke 36: 2595-2600 [Abstract] [Full text]  
  • U-King-Im, J M, Trivedi, R A, Graves, M J, Harkness, K, Eales, H, Joubert, I, Koo, B, Antoun, N, Warburton, E A, Gillard, J H, Baron, J-C (2005). Utility of an ultrafast magnetic resonance imaging protocol in recent and semi-recent strokes. J. Neurol. Neurosurg. Psychiatry 76: 1002-1005 [Abstract] [Full text]  
  • Briley, D. P, Meagher, T. (2004). Scan immediately for stroke using MRI when possible. BMJ 328: 1135-1135 [Full text]  

Rapid Responses:

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Project now published as an HTA monograph
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