Cerebrovascular disease

Cerebrovascular disease can present as stroke, transient ischaemic attack or amaurosis fugax, due to vaso-occlusive disease in the cerebral circulation, usually due to emboli from carotid atheroma plaques. Diagnosis is on clinical grounds +/- imaging and managment should focus on primary and secondary prevention as much as possible.

Blood glucose

This is a mandatory investigation in any one presenting with focal neurological symptoms/signs as this may be a presentation of hypoglycaemia.

HbA1c

An essential baseline when considering any diabetes complication.

Fasting lipids

A full fasting lipid profile including total and HDL cholesterol, LDL cholesterol and triglycerides is an important first step to managing cardiovascular risk in diabetes.

U+Es

An essential baseline when considering any diabetes complication. It may also alert the physician to the potential presence of reno-vascular disease.

ECG

An ECG should be performed to detect any signs of ischaemic heart disease and to confirm the cardiac rhythm.

CT head

Any patient with ongoing symptoms (i.e. stroke in evolution) should undergo urgent CT head as they may be suitable for thrombolysis, if this service is available.

The CT differentiates ischaemic from haemorrhagic stroke and also excludes other differential diagnoses such as neoplasm, subdural haematoma or abscess.

Carotid Doppler studies

These are essential in any patient presenting with stroke, TIA or amaurosis. They assess the extent of carotid atheroma, and thus potential for endarterectomy, in order to potentially prevent a future catastrophic stroke.

Cardiac echo

This is a routine part of the work-up of any cerebrovascular disease patient in order to exclude a potential cardiac thrombus, which may be the cause of emboli, and to screen for patent foramen ovale.

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