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Brain Stroke Protocol

Last Updated: 2026-01-01 Author:

  • 1. Clinical Summary

    Series Phase Coverage
    NC Head Non-contrast Vertex to Foramen magnum
    CTA Arch to Vertex Arterial (bolus tracked) Aortic arch to Vertex
    CTP (optional) Contrast (Auto-triggered delay) Skull base to Vertex
    • Acute stroke
    • CVA
    • Neurological deficit < 24 hours
    • Stroke code

  • 2. Patient Prep

    • Position: Supine head-first
    • NPO Status: None - emergency

  • 3. IV Contrast & Injection

    Parameter Value
    Agent IsoVue 370 for CTA/CTP
    Volume 100 mL
    Flow Rate 4-5 mL/s
    Timing Method Multi-phase stroke protocol
    ROI Placement Multiple ROIs
    Trigger (HU) Varies

    Use full dose if GFR > 30

    If GFR < 30

    Max Contrast = \(2*\left[\frac{\text{Patient Weight}}{75 \text{ kg}} * \text{eGFR}\right]\)

  • 4. Special Notes

    • STAT protocol: 1) NC Head 2) CTA Head/Neck (aortic arch to vertex) 3) CTP (optional). Minimize door-to-scan time
    • Additional Recons: CTA MIP and 3D. CTP perfusion maps if done. ASPECTS score. LVO documentation
    • No IV for NC. Large bore for CTA/CTP. STAT coordination

    Safety First

    • Renal Function: Emergency proceed
    • Allergy: STAT protocol
    • NC: hemorrhage early ischemia hyperdense vessel. CTA: LVO large vessel occlusion. CTP: penumbra core mismatch
    • STAT protocol. Minimize delays. LVO detection critical
Series Name Start Location End Location Delay Slice Thickness Notes
Scout Vertex Aortic arch N/A N/A STAT lateral
NC Head Skull base Vertex N/A 5 mm STAT no contrast
CTA Arch to Vertex Aortic arch Vertex Bolus tracked aorta 0.625 mm Intracranial vessels
CTP (optional) Skull base Vertex Auto-triggered 5 mm dynamic Perfusion if candidate
Plane Acquisition FOV Thickness/Increment Kernel IR Strength Notes
Axial NC head Brain 5 mm/5 mm Brain 3 STAT hemorrhage detection
Axial CTA Arch to Vertex Head and Neck 1 mm/1 mm Brain 3 LVO detection
MIP CTA Circle of Willis Thick slab Brain N/A Vessel overview
CTP maps CTP Perfusion Color maps N/A N/A CBF CBV MTT Tmax maps