In some very efficient facilities, vascular, blood, and cardiac tests can be performed and the results reported back to the treating physician quickly. In contrast, patients suspected of having embolism, severe carotid or intracranial large artery occlusive disease, and subarachnoid and intracerebral hemorrhage are best evaluated in the hospital because they are at risk of rapid evolution of neurological signs, and the likelihood of their requiring treatment best performed in the hospital is great. Stroke and cerebrovascular disease are extremely serious conditions that threaten life and brain function. All patients deserve a thorough evaluation to determine the cause of their symptoms and to identify important disorders that carry a risk of future cardiovascular and cerebrovascular events. There is a very high frequency of coexisting coronary artery and cerebrovascular disease.
Many patients have multiple risk factors.
Treatment must be directed at the pathogenesis of the cerebrovascular symptoms and signs. The outlook for progression or new brain ischemia depends on the etiology, not the time course of symptoms. Treatment should be tailored to the individual patient. If embolism is the problem, then removal of the embolic source and modification of the coagulation system to prevent further emboli are indicated. When the cause and location of the vascular lesion and state of the brain are known, then physicians are in position to evaluate the brain tissue at risk of further infarction.