Labs
POC glucose
CBC
Chemistry
Coags
Troponin
T&S
ECG
In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes
Head CT (non-contrast)
In ischemia stroke CT has sensitivity 42%, specificity 91%
In acute ICH the sensitivity is 95-100%
The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)
Also consider:
CTA brain and neck
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
Pregnancy test
CXR (if infection suspected)
UA (if infection suspected)
Utox (if ingestion suspected)
POC glucose
CBC
Chemistry
Coags
Troponin
T&S
In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes
In ischemia stroke CT has sensitivity 42%, specificity 91%
In acute ICH the sensitivity is 95-100%
The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)
CTA brain and neck
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
Pregnancy test
CXR (if infection suspected)
UA (if infection suspected)
Utox (if ingestion suspected)
To check for large vessel occlusion for potential thrombectomy
Determine if there is carotid stenosis that warrants endarterectomy urgently
MRI Brain with DWI, ADC (without contrast) AND
Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):
MRA brain (without contrast) AND
MRA neck (without contrast)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
MRA brain (without contrast) AND
MRA neck (without contrast)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA) (ACEP Level C)
Hemorrhagic stroke
Intra-axial
Ischemic stroke
Hemorrhagic stroke 
Subarachnoid hemorrhage
Traumatic intracerebral hemorrhage
Stroke 
Extra-axial