CVD DIAGNOSTIC EVALUATION

Cerebral Angiography , digital subtraction angiography, CT angiography, MRA, Doppler u/s all provide information about carotid and intracranial circulation Partial Prothrombin time (PTT) or International Normalized Ratio (INR) if anticoagulation is considered. Blood levels are monitored to document therapuetic ranges and determine dosing. PTT is utilized for heparin therapy and INR is utilized for oral warfarin (Coumadin) therapy.

 Diffusion-weighted MRI may be done to rule out stroke. Transesophageal echocardiography to rule out emboli from heart.

CVA DIAGNOSTIC EVALUATION

 Carotid u/s to detect carotid stenosis CT Scan to determine the cause and location of stroke MRA or CT Angiogram noninvasive evaluation of cerebrovascular structures Cerebral angiography to determine extent of cerebrovascular insufficiency & to evaluate for structural lab abormalities

 PET, MRI with diffusion-weighted images to locate ischemic damage TCD noninvasive method used to evaluate cerebral perfusion. Useful in the bedside evaluation and to provide a means for ongoing monitoring of cerebral blood flow to document changes and trends.

PET

TCP

Rupture of Intracranial Aneurysm DIAGNOSTIC EVALUATION

 History and Physical Exam CT Scan to determine presence of blood in subarachnoid space, rule out other lesions, and to evaluate mass effect. Lumbar Puncture (if no mass effect on CT): grossly bloody CSF w/ more than 25,000 RBCs, CSF will not clear w/ subsequent taps as a traumatic tap would.

 MRI and MRA or CT Angiogram noninvasive evaluation of cerebral vascular structures. Can be useful in the workup of suspected aneurysms (individuals w/ persistent headaches or unexplained neurologic deficits such as cranial nerve palsies). Cerebral angiogram gold standard test; provides definitive evaluation of aneurysm etiology, presence, location & configuration; will also reveal presence of vasospasm, extent of vasospasm & collateral circulation.

 TCD noninvasive method used to evaluate cerebral perfusion. Useful in the bedside evaluation and to provide a means for ongoing monitoring of cerebral blood flow to document changes and trends.

Rupture of Intracranial Arteriovenous Malformation

DIAGNOSTIC EVALUATION

 History and Physical Examination CT Scan to determine presence of blood, rule out other lesions; increased density if blood is present, may also show increased ICP or mass effect MRI and MRA or CT Angiogram noninvasive evaluation of cerebral vascular structures. Useful in the diagnosis of AVM, but does not define vascular changes and flow patterns.

 Cerebral angiogram gold standard test; provides definitive evaluation of AVM presence, location, & vascular structure. Will also evaluate flow patterns, pressure gradients, collateral circulation, identify intranidal aneurysms, & feeding vessels.