When are hematologic and serologic tests indicated in the evaluation of posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

If the stroke mechanism is not evident from the medical history and routine workup, then special hematologic and serologic examinations should be considered, particularly in young patients with cryptogenic stroke. A full hypercoagulable workup should include assays for arterial thrombophilia, including antiphospholipid antibodies and lupus anticoagulant.

Additional assays for venous thrombosis may be obtained in the appropriate clinical setting (ie, patent foramen ovale with paradoxical embolism) and include protein C, protein S, factor V Leiden/activated protein C resistance, antithrombin III, and prothrombin gene polymorphism. Some of these assays give abnormal results in the setting of acute stroke or anticoagulant medications and may need to be obtained on a delayed basis. The use and value of hypercoagulable disorder assessments remains a somewhat imprecise and controversial area of stroke neurology.


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