Medical / non-neurological examinations in suspected circulatory disturbance of the brain

1. Big picture

When a patient presents with suspected stroke or transient ischemic attack (TIA), the neurologist must localize the lesion and identify the vascular territory, but the medical / non-neurological workup answers equally important questions:

1. Is this really stroke, or a medical mimic? Hypoglycemia, hyperglycemia, arrhythmia, syncope, infection, intoxication, electrolyte disturbance, and hypertensive emergency can all mimic neurological disease.

2. Is the patient physiologically stable? Stroke patients may die from aspiration, pneumonia, myocardial infarction, pulmonary embolism, arrhythmia, or respiratory failure, not only from the brain lesion itself.

3. Is reperfusion treatment safe? Before thrombolysis, we must know glucose, platelet count, coagulation status, anticoagulant use, renal function if contrast imaging is needed, and general contraindications.

4. What caused the stroke? Cardiac embolism, atrial fibrillation, myocardial infarction, endocarditis, valve disease, carotid atherosclerosis, hypertension, diabetes, dyslipidemia, and coagulation disorders must be searched for.

The examiner usually wants you to say: stroke diagnosis is not only CT/MRI and neurological signs; it also requires vital signs, glucose, ECG, cardiac evaluation, laboratory tests, vascular risk assessment, and monitoring.