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Is routine computed tomography in strokes unnecessary?

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.

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 …