Education And Debate

Controversies in Management: Computed tomography provides accurate diagnosis

BMJ 1994; 309 doi: (Published 03 December 1994) Cite this as: BMJ 1994;309:1498
  1. Joanna M Wardlaw, senior registrar in neuroradiologya
  1. a Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU

    The term stroke describes a clinical event that can be due to several underlying conditions. Patients with stroke are investigated to help clinicians to separate strokes from non-strokes; distinguish cerebral haemorrhage from cerebral infarction; and identify specific pathophysiological subtypes of cerebral infarction. This information aids decisions about treatment and helps determine prognosis.1 Investigations are of clinical benefit only if they improve diagnostic accuracy beyond that which can be obtained from the history and examination of the patient. Computed tomography of the brain is the quickest, most practical method of diagnosing the cause of stroke.

    What do “experts” think?

    Several statements from experts have suggested that computed tomography is useful in patients with stroke. In 1988 the King's Fund issued a consensus statement that said: “There is a strong case for scanning most patients who present with a presumptive stroke, excluding those in whom antithrombotic treatment is contraindicated. The resources required to scan this large group of patients may well be outweighed by a reduction in the recurrence of strokes and myocardial infarcts and in the associated costs of health care.”2 In 1990 the Royal College of Physicians of London concluded that “All patients who present with the acute onset of a focal neurological …

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