Evaluation of ischemic stroke and recurrent ischemic attack

Stroke is the leading cause of adult disability in the United States, with an annual cost of $30 billion. Defining stroke etiology is essential for initial treatment and prevention of recurrent stroke. In this article, we discuss the laboratory evaluation of patients with cerebral ischemia. In most patients older than 50 years with clear risk factors, the analysis is straightforward and inexpensive. In younger patients or those without standard risk factors, however, further laboratory investigation often is necessary. We discuss specific laboratory tests investigating common etiologies, such as atherothrombosis, and uncommon causes including prothrombotic states, metabolic abnormalities, and hyperviscosity syndromes. Optimally, a focused investigation defines etiology and evaluates risk factors, thus reducing risk of recurrent stroke and improving long-term outcome. This is the final article in a three-part continuing education series on neurology. Other articles focused on multiple sclerosis and neuropathy syndromes. The exam follows this article.