ZocdocAnswersIs this indicative of a ischemic stroke?

Question

Is this indicative of a ischemic stroke?

Would "Moderate ventricular enlargement and diffuse cortical volume loss redemonstrated with small vessel ischemic changes (as compared to a noncontrast CT scan from a month earlier) suggest an ischemic stroke occurred? Immediately after this, trandate was administered and then 5000 units of heparin 2x daily for the next 5 days was administered? Patient is 81 year old female with blood sodium level of 149 and creatinine level of 56 (no other lab work out of range) Thanks

Answer

The best way to evaluate whether an ischemic stroke took place is to obtain a brain MRI and to review it with a radiologist, neuro-radiologist, or neurologist. I recommend that you take these measures in order to accurately assess this particular patient's case. Having said that, a non-contrast head CT is mainly only useful in the evaluation for an intracranial hemorrhage, such as a subdural hematoma, epidural hematoma, subarachnoid hemorrhage, or intraparenchymal hemorrhage. It can also be used to identify large mass lesions, as this can cause a midline shift on the image. An MRI is much more sensitive in identifying ischemic strokes. Based on the details you have given from the imaging modality you obtained, there is no evidence (again based on the details you provided) for an acute ischemic stroke. However, again, an MRI, especially with diffusion weighted imaging in the acute setting, is much more sensitive to identify such a stroke. The small vessel changes are likely from chronic small white matter infarcts due to atherosclerosis and hypertension. The moderately enlarged ventricles and cortical volume loss can be associated with aging or different types of dementia, and do not indicate that an acute ischemic stroke took place. Importantly, and for the care of your patient, I recommend reviewing the imaging with one of the specialists listed above, so that they can actually see the images and have access to the full report.

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