U said in management of stroke that after doing CT we so DWmri which if found normal no further inv required
My doubt is dwmri only show infarcts and not ischemia
So even if dwmri normal it can be that there is an ischaemia
Shouldnt we do anything to find out that ischaemia ?
If you are suspecting stroke clinically then you are trying to find out infarct in brain imaging. If you dont find it in brain imaging then may be it was TIA. You can repeat imaging as it may take time to develop changes in brain. To rule out the conditions that can precipitate such situation you can do carotid artery doppler etc such investigations.Rule out AF. Do Echo.Check lipid profile,CBC etc.
There’s something known as stroke protocol which includes the following investigations:- CT angiogram head and neck vessels, MRI DWI, 2D ECHO, Holter, homocysteine, cbc, LFT, kft, TFT, Vitamin B12, HbA1c, Lipid profile, Vitamin D3. Clinical findings supersede the examination part. Radiological investigations like CT angiogram help us to detect any vascular stenosis or thrombotic plaques. If patient present presents within the golden hour of stroke and we do detect a thrombus in the vessel, options like mechanical thrombectomy or thrombolysis with tPA are done depending on when the patient presents. MRI DWI tells us the areas of ischaemic territory. Though sometimes areas of ischaemia take time to appear on it. If both CT angiogram and MRI DWI are normal, and clinical examination reveals no neurological deficits Then patient is managed on the lines of TIA.