Announcements: Neuromuscular section updated with more questions.

HISTORY:  Regular ischemic stroke workup and additionally ask about:

  • Family history of hyper-coagulable states, early heart disease, connective tissue disease
  • If female, on oral contraceptives? Smoker?

EXAM:  same as adult ischemic stroke, include Fundoscopic exam to eval for sinus thrombosis. 

WORKUP: In addition to the regular stroke w/u, you may check the following:

 Hypercoaguable State:

  • PT, PTT, thrombin time, fibrinogen
  • “Hypercoagulable panel:” Includes APC Resistance,  Antithrombin III, Protein C, Protein S
  • Acquired hypercoaguable screening:
  • Lupus anticoagulant screen (DRVVT) (order in SCM is Dilute Russell Venom Viper”)
  • Anti-Cardiolipin antibody
  • Anti Beta-2 glycoprotein-1 antibody
  • Anti-phospholipid antibody (APLS) (order in SCM is “Lupus”)
  • Hemoglobin screen if African American or Mediterranean
  • Fasting homocysteine (If above 14, check folate, vitamin B12 and MTHFR 677T gene mutation)
  • Lipoprotein A
  • Prothrombin 20210 gene mutation
  • If suspect metabolic disorder, urine amino and organic acids and lactate and pyruvate

Rheumatologic Disorders:

  • ESR, CRP
  • ANA, ENA, dsDNA, Rheumatoid Factor, ANCA
  • Antiphospholipid Antibody
  • C3 (total level), C4 (total level)
  • Cryoglobulins
  • Hepatitis Panel
  • HIV


  • MRV or CTV brain
  • TTE with bubble study
  • TEE
  • Lower extremity Dopplers (including calves)
  • MRV of the pelvic veins (order MRA abdomen/pelvis w/ gad and specify venogram in comments)
  • CT chest/abdomen/pelvis to look for malignancy

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