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  #1  
Old 11-13-2014
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Default CNS Question

A 77 years old male was brought to the ER by his neighbors after he failed to appear from his home for two days. On examination he is mildly dehydrated but otherwise he is stable. Motor exam shows that power is one over the left upper extremity and zero over the left lower extremity. Besides this, speech is conserved and left to right orientation is affected. The patient has depressed mood and on careful questioning the patient states that weakness started two days back when he woke from his sleep. He is a known diabetic for the past 13 years on Metformin and he is also taking Enalapril and Aspirin. He was a smoker for 30 years but has currently quit.

What is the best initial test?

A. CT with contrast
B. CT without contrast
C. MRI
D. Carotid Doppler
E. Trans-esophageal Echo

Explanation is very important
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Old 11-14-2014
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CT without contrast is always the best initial test. According to the signs that the px presents and the history , it is likely that he has had an stroke. The only test that can tell u if it is either a ischemic or hemorrahagic stroke is the noncontrast CT.

Ct scan are often negative for ischemia within th first 48h of symptom onset. In this case a Difussion-weighted MRI is the test if choice for detection ischemia.
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Old 11-17-2014
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CT without contrast is the initial test of choice in stroke to rule out haemorrhagic stroke.
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