3. Stroke in the emergency room
3.1 Is this a stroke?
3.1.2 Diagnosis
There is currently no 100% sensitive and specific test for cerebral infarction in the emergency department, so that the diagnosis is usually made on the basis of a characteristic history, exam, presence of comorbidities, and the absence of seizures or other stroke mimics.
CT scanning is usually negative in the first three hours, or shows only subtle signs that have low inter-observer reliability. If available, MR imaging, or detection of an occluded artery by transcranial Doppler or arteriography (by CT, MRI or intra-arterial catheterization), can be confirmatory.
Parenchymal or subarachnoid hemorrhage, on the other hand, can be reliably detected by emergent CT scanning.
