When there are symptoms of stoke, is MRI or CT the first diagnostic imaging modality?

Question

stoke = stroke

Answer 1

CT is the initial imaging modality of choice. First, it's more easily obtainable. Second, it's fine for the important question: bleed or no bleed. Third, bad things can happen in the machine, and as of now, CT tends to be in and out in a few minutes, where MRI can take a half hour or longer.
Finally, if you aren't one of those enamored of the NINDS study, you aren't in a hurry to do anything dramatic anyway unless there's a surgically correctible problem, so the level of diagnostic certainty and precision needed is not such that the extra trouble and expense of MR is generally worth it.

Answer 2

How is a diagnosis made?

When you or a loved one is brought to the emergency room with a stroke, the doctor will learn as much about your symptoms, current and previous medical problems, current medications, family history, and perform a physical exam. If you can't communicate, a family member or friend will be asked to provide this information. Diagnostic tests are used to help the doctors determine whether they need to unblock a clogged artery (in ischemic stroke) or stop the bleeding (in hemorrhagic stroke).

Lumbar puncture: If a hemorrhagic stroke is suspected, the doctor may perform a lumbar puncture (spinal tap), which is used to detect blood in the cerebrospinal fluid and indicates bleeding into the subarachnoid space of the brain.

Computed Tomography (CT) scan is performed for both ischemic and hemorrhagic strokes. CT is a safe, noninvasive X-ray to review the anatomical structures within the brain to see if there is any bleeding in or around the brain. A newer technology called CT angiography involves the injection of contrast into the blood stream to view the arteries of the brain and find blockages.

Angiogram is an invasive procedure, where a catheter is inserted into an artery and passed through the blood vessels to the brain. Once the catheter is in place, a contrast dye is injected into the bloodstream and the X-ray images are taken. This is used to diagnose and determine the location of aneurysms and AVMs.

Magnetic resonance imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of your brain. An MRA (Magnetic Resonance Angiogram) is the same non-invasive study, except it is also an angiogram, which means it also examines the blood vessels, as well as the structures of the brain.

Answer 3

MRI had an overall accuracy of 84% for the diagnosis of acute stroke, compared to 54% for CT...according to the National Institutes of Health.

MRI better be your number one request.

Answer 4

Symptoms include:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause