IMAGING STUDIES of HEMİPLEGİA

Urgent imaging studies are done to differentiate cerebral ischemia from cerebral
hemorrhage.
CT brain
Immediately excludes hemorrhage
Can detect cerebral edema
Smallest infarct that can be made out –0.5 –1 cm
Demerits: cannot detect most infarcts for at least 24 hrs
 Does not detect lesions in cortical surface or brain stem
MRI:
More sensitive than CT in detecting ischemic stroke; better resolution;
Within hours, infarct can be detected including infarcts in posterior fossa, cerebral
surface and lacuna infarcts of less than ½ cm
Hemorrhagic infarcts can be made out.
Blood flow in many intracranial arteries may be imaged.
Sections in all planes possible; can diagnose demyelinating diseases
Demerits: Expensive, Not available all 24hrs; claustrophobia

3. Positron emission Tomography
Advantage: assesses the function of the neurons
4. SPECT: Single Proton Emission Computerised Tomography
5. DSA; Digital Subtraction Angiography of cerebrum
In cases of stroke ‘time is brain,’ and thus loss of time due to an
extensive diagnostic work-up is contraindicated P a g e | 19

Usually performed by retrograde femoral artery catheterization

• Four vessel cerebral angiography if indicated in TIA
• MR angiography in Vertibro basilar involvement
Other studies
6. Spinal tap: To diagnose encephalitis or multiple sclerosis
7. ECG, ECHO, Holter monitor: for evaluation of suspected embolic stroke TIA.
8. Coagulation studies: including PT and PTT –especially in patients receiving
anticoagulant or thrombolytic therapy and in patients with cerebral hemorrhage.
9. Look for hypercoagulable states in young.
10. Cardiolipin antibodies, lupus inhibitors if antiphospholipid syndrome is
suspected.

11..Routine blood tests; blood count, Hb, sugar, urea, creatinine
12. Serum electrolytes
13. X-ray chest-to detect cardiac disease, lung abscess, empyema
14. Non invasive carotid tests:, Carotid ultrasound techniques, Ophthalmo
dynamometry, Oculo plesthismography ‘Directional supra orbital Doppler-’Trans
cranial Doppler’
15. Blood culture