N.T., a 79-year-old woman, arrives at the emergency room with expressive aphasia, left facial droop, left
sided hemiparesis, and mild dysphagia.
Her husband states that when she awoke that morning at 0600,
she stayed in bed, complaining of a mild headache over the right temple and feeling slightly weak. He
went and got coffee, then thinking it was unusual for her to have those complaints, went back to check
on her. He found she was having some trouble saying words and had developed a left-sided facial droop.
When he helped her up from the bedside, he noticed weakness in her left hand and leg and brought
her to the emergency department. Her past medical history includes paroxysmal atrial fibrillation (PAF),
hypertension (HTN), and hyperlipidemia. A recent cardiac stress test had normal findings, and her blood
pressure (BP) has been well controlled. N.T. is currently taking flecainide (Tambocor), hormone replace
ment therapy, amlodipine (Norvasc), aspirin, simvastatin (Zocor), and lisinopril (Zestril). The physician sus
pects N.T. has experienced an acute cerebrovascular accident (CVA).
What role do diagnostic tests play in evaluating N.T. for a suspected CVA?
Noncontrast computed tomography (CT) scan is the primary test used to diagnose a stroke. CT can
indicate the size and location of the lesion and differentiate between ischemic and hemorrhagic
stroke. For optimal results, the CT scan should be obtained within 25 minutes and read within 45
minutes of arrival at the emergency department. If the stroke is ischemic and is less than 3 hours old,
the CT will appear normal because the brain structure with or without blood flow appears the same
in a noncontrast CT scan. N.T. has a history of PAF; an electrocardiogram (ECG) will be necessary
to evaluate rhythm status. An echocardiogram would be helpful for evaluating the possibility of
thrombi in the atria or ventricle. A carotid ultrasound is used to identify any atherosclerotic plaques.
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What will be an ideal response?