In suspected acute ischemic stroke, what is the initial imaging study used to exclude hemorrhage?

In suspected acute ischemic stroke, what is the initial imaging study used to exclude hemorrhage?

• A. Non-Contrast CT
• B. MRI diffusion-weighted imaging
• C. CT angiography
• D. FDG-PET scan

Answer: (A)

In suspected acute ischemic stroke, the first imaging step is to quickly rule out a brain bleed before considering therapies like thrombolysis. A non-contrast head CT is used because it can be performed rapidly, is widely available in emergency settings, and is highly effective at detecting acute intracranial hemorrhage without the need for contrast. This immediate hemorrhage exclusion guides urgent treatment decisions. While MRI diffusion-weighted imaging is very sensitive for early infarction, it takes longer and is not always readily available in the acute setting, so it isn’t the initial study. CT angiography adds vascular detail for assessing occlusions but isn’t the primary test for ruling out hemorrhage. FDG-PET has no role in the acute stroke evaluation.

In suspected acute ischemic stroke, the first imaging step is to quickly rule out a brain bleed before considering therapies like thrombolysis. A non-contrast head CT is used because it can be performed rapidly, is widely available in emergency settings, and is highly effective at detecting acute intracranial hemorrhage without the need for contrast. This immediate hemorrhage exclusion guides urgent treatment decisions. While MRI diffusion-weighted imaging is very sensitive for early infarction, it takes longer and is not always readily available in the acute setting, so it isn’t the initial study. CT angiography adds vascular detail for assessing occlusions but isn’t the primary test for ruling out hemorrhage. FDG-PET has no role in the acute stroke evaluation.