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Practice guidelines for the use of imaging in transient ischemic attacks and acute stroke. A report of the Stroke Council, American Heart Association.

In the modern clinical setting the practitioner can order a variety of imaging procedures for the evaluation of stroke patients or patients at risk of stroke. New procedures have improved accuracy and lessened invasiveness but increased the complexity of decision making. When all of the standard imaging techniques are available, a sequential choice must be made to optimize diagnostic yield, reduce the risk of harm to the patient, and minimize cost. Difficulties may arise when the practitioner is limited by the choice of diagnostic methods available or cost-containment policies. These guidelines are intended to update clinicians in the use of diagnostic imaging procedures in patients with acute stroke or at high risk of stroke and to provide insight for their sequential use in a hierarchical order of specificity and practicality. The target audience is physicians who care for patients with stroke, including specialists in neurology, neurosurgery, vascular surgery, internal medicine, emergency medicine, critical care medicine, and family medicine. The panel has endeavored to strike a balance between the tertiary care setting and the community hospital, offering practical recommendations that can be implemented in these settings, where most patients with acute stroke are treated. Advanced technology methods, unproved techniques, and clinical research strategies may be mentioned but are not recommended.

The first section discusses the diagnostic imaging evaluation of the patient with transient ischemia at high risk of stroke. The second section explains the approach to the patient with acute stroke. The third and fourth sections are complementary, dealing with special conditions such as subarachnoid hemorrhage, arteritis, dural sinus and venous thrombosis, arterial dissection, and spinal cord stroke. Recommendations for procedures in women of child-bearing age and patients intolerant of contrast solutions are also made.

These guidelines should be supplemented by consulting the literature citations provided in the reference section. Ultrasonography …