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Stroke Imaging in Primary Care: A Practical Guide for Family Physicians

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

Medical Director, Journal of Current Clinical Care and www.healthplexus.net, Radiologist, Orillia Soldiers’ Memorial Hospital, Adjunct Clinical Lecturer, Departments of Medical Imaging and Family Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract:
Stroke remains a leading cause of mortality and long-term disability, with optimal outcomes dependent on rapid recognition and timely intervention. Family physicians play a crucial role in the acute stroke care pathway, from initial assessment to long-term secondary prevention. Understanding contemporary stroke imaging protocols, recognizing early signs of cerebrovascular events, and knowing when to initiate urgent referral can significantly impact patient outcomes. This review provides family physicians with practical guidance on stroke imaging principles, current best practices, and clinical decision-making frameworks to optimize care for patients with suspected acute stroke.

Key Words: stroke, imaging, cerebrovascular events, patient outcomes, acute stroke.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
Rapid Referral Over Time Windows—Modern stroke care extends treatment windows up to 24 hours with imaging guidance. Family physicians should refer ALL suspected stroke patients immediately, regardless of time from onset.
Recognition and Referral, Not Diagnosis—Primary care role is rapid recognition using simple tools (facial droop, arm weakness, speech difficulties) and immediate transport coordination—not comprehensive evaluation or imaging interpretation.
CT Excludes Hemorrhage, Doesn’t Confirm Stroke—Non-contrast CT’s main purpose is excluding bleeding, not confirming ischemic stroke. Normal CT should never delay referral for suspected stroke.
Advanced Imaging Guides Treatment—Multimodal imaging (CT + angiography + perfusion) identifies large vessel occlusions for thrombectomy and estimates salvageable brain tissue for individualized treatment decisions.
Time Windows Don’t Exclude Patients—Advanced imaging can identify treatment candidates many hours after traditional windows—don’t use time to exclude patients from specialist evaluation.
Watch for Subtle Posterior Strokes—Isolated dizziness/vertigo in older patients may be posterior circulation stroke, especially with coordination or visual symptoms.
Check Blood Glucose Only—Correct abnormal glucose before referral—hypoglycemia mimics stroke and hyperglycemia worsens outcomes. Skip other tests to prioritize speed.
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Related Terms: Radiology, stroke
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