Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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In the acute setting, the Non-Contrast Head CT (NCCT) remains the initial diagnostic workhorse. Its primary role is singular: to rule out hemorrhage. Blood appears bright white (hyperdense) on CT. If blood is present, clot-busting drugs are contraindicated.
While CT is insensitive to early ischemia (the stroke might not show up for 6-12 hours), early signs can sometimes be seen. The “Hyperdense Vessel Sign” indicates a visible clot inside an artery. The “ASPECTS” score is a systematic way of looking at the CT to quantify how much of the brain is already damaged, which helps guide treatment decisions.
Once hemorrhage is ruled out, the vascular tree must be mapped. CT Angiography (CTA) involves injecting contrast dye to visualize the arteries from the aortic arch to the vertex. This is critical for identifying Large Vessel Occlusions (LVO)—blockages in the main pipes that are accessible for mechanical removal.
CT Perfusion (CTP) is a functional scan. It measures how fast blood is moving through the brain tissue. It generates maps distinguishing the “core” (dead tissue, low blood volume) from the “penumbra” (starving tissue, delayed transit time). A large mismatch between core and penumbra indicates salvageable brain, justifying aggressive treatment even in delayed time windows.
MRI is the gold standard for defining the infarct core. Diffusion Weighted Imaging (DWI) is a sequence sensitive to the movement of water molecules. In ischemic cells, the sodium pumps fail, water rushes in, and cellular swelling restricts water motion. This appears as bright signal on DWI within minutes of onset.
MRI is also essential for determining the “age” of a stroke. If a stroke is visible on DWI (cellular swelling) but invisible on FLAIR (fluid sequence), it indicates the stroke is less than 4.5 hours old. This “DWI-FLAIR mismatch” can qualify patients for thrombolysis even if they woke up with the stroke and the exact time of onset is unknown.
Ultrasound provides a dynamic assessment of blood flow without radiation. Carotid Duplex ultrasound assesses the arteries in the neck for atherosclerosis (plaque) and stenosis (narrowing). Velocity measurements can quantify the degree of blockage.
Transcranial Doppler (TCD) uses sound waves to penetrate the thin parts of the skull to measure flow velocity in the brain’s arteries. It is used to monitor for vasospasm after subarachnoid hemorrhage, detect micro-emboli (HITS) passing through the circulation, and assess the patent foramen ovale (PFO) via a “bubble study.”
Since approximately 30% of strokes are cardioembolic (clots traveling from the heart), the heart is considered part of the neurovascular investigation. Transthoracic Echocardiogram (TTE) looks for structural thrombi or valvular vegetations. In some cases, a Transesophageal Echocardiogram (TEE) is needed to see the Left Atrial Appendage, a common hiding spot for clots in atrial fibrillation.
Detecting paroxysmal (intermittent) atrial fibrillation is a major diagnostic challenge. Standard EKGs often miss it. Vascular neurologists utilize long-term cardiac monitors—ranging from 30-day external Holter monitors to implantable loop recorders (ILRs) that sit under the skin for years—to catch these elusive rhythms.
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The loud banging noises are created by the magnetic coils switching on and off rapidly to create the magnetic gradients needed to construct the image; it is normal physics, not a malfunction.
Yes, the old belief that shellfish allergy predicts iodine contrast allergy is a myth; however, if you have had a reaction to contrast dye specifically before, you need premedication.
This refers to a patient who goes to sleep normal and wakes up with stroke symptoms; because we don’t know exactly when in the night it happened, specialized imaging (MRI) is needed to see if treatment is safe.
Penumbra is the Latin word for “shadow”; in neurology, it refers to the brain tissue that is in the shadow of the stroke—stunned and starving, but not yet dead, and savable with fast treatment.
Yes, a Transesophageal Echocardiogram involves swallowing a probe down the esophagus to look at the heart from the inside; it requires sedation to be tolerable.
Nearly 800,000 Americans suffer from strokes each year. Carotid artery disease is a big reason for these strokes. carotid artery disease happens when plaque builds
Those with carotid artery stenosis face a big risk of stroke. The Medical organization warns that ignoring this condition can lead to serious problems. A
Feeling dizzy, falling, or fainting can be scary and serious. Doctors often use carotid sinus massage to check these symptoms.what is carotid massageAtrial Tachycardia vs
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