The objectives of identifying stroke risk factors are:
- to identify specific pathophysiological subtypes of cerebral infarction with different management and prognosis
- to ascertain specific risk factors and their possible prevention
Investigations that might contribute to these goals include:
- chest X-ray - cardiac enlargement in hypertension or valvular disease
- retinal examination - retinopathy in hypertension, embolic disease
- ECG - ventricular enlargement and/or arrhythmias in hypertensive/embolic disease; recent MI in embolic disease; conduction defect - embolic / output failure
- blood glucose - for hyperglycaemia in diabetes mellitus
- serum cholesterol and lipids - hyperlipidaemia in patients under 65 years
- ESR, auto-antibodies - for vasculitis, collagen vascular disease
- full blood count - for polycythaemia, thrombocytopenia
- urine analysis - polyarteritis, thrombocytopenia
- other haematological tests as indicated - e.g. neurosyphilis
- cervical spine X ray - for atlanto-axial subluxation
- note drug history - oral contraceptives, amphetamines, opiates
Further investigations as indicated:
- blood culture - if suspected infective endocarditis
- sickle cell screen, plasma electrophoresis, viscosity studies
Reference
- National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. April 2022 [internet publication].