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Do you typically recommend inpatient stroke evaluation for patients with incidentally found asymptomatic stroke on outpatient imaging?

For patients undergoing outpatient MR imaging for other indications who have instantly found acute stroke, do you typically recommend the patient be admitted to the hospital and undergo a complete stroke evaluation even if the finding is silent? Or would you typically work this up as an outpatient?
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For patients with incidentally found stroke with no clinical deficits on outpatient imaging, do you typically recommend inpatient stroke work up?

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5 Answers
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Neurology · NCH Healthcare System
Answered on

This of course depends on so many variables, some scenarios and questions that matter in making the decision:

  1. Why was the imaging done in the first place? Not relevant to stroke or imaging was done because of TIA?
  2. What were the initial symptoms? Are you suspecting a large vessel occlusion (shocking...

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Neurology · Vanderbilt University Medical Center
Answered on

No, I would do a stroke work-up, CTA or MRA, and echocardiogram, as well as consideration of monitoring and also the management of risk factors. These could all be done on an outpatient basis. An inpatient stroke work-up would not be necessary.

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Neurology · Cleveland Clinic
Answered on

A lot of good and interesting answers.

The short answer for me is, if you have the resources, yes. Admit the patient and get the work-up done ASAP.

A silent infarct has the mechanisms any other stroke has, the patient was just lucky it hit an area of the brain that was not eloquent. Would you admit t...

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Neurology · Multicare Health System
Answered on

Too many variables in question to make a simple call in or out patient workup.

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Neurology · Boice-Willis Clinic, P. A.
Answered on

Stroke prevention by identifying the etiology of the silent stroke.

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