Cervical artery imaging: (duplex, CT angiography or MR angiography), to identify significant carotid stenosis (where surgery might be considered) or cervical artery dissection or vasculitis, for example Takayasu arteritis.

Echocardiography:

• Transthoracic echocardiography (TTE) where a cardio-embolic cause for stroke is being considered. If the patient is in known atrial fibrillation, then may not need echocardiography as patient will be anticoagulated anyway. Use to look for endocarditis, aortic dissection, atrial myxoma or where there is an undiagnosed cardiac murmur or abnormal ECG.
• Use transthoracic echocardiography with bubble injection where patent foramen ovale is suspected.
• Consider transoesophageal echocardiography (TOE) for patients with possible endocarditis and a normal TTE, mechanical heart valve prosthesis and for unexplained stroke in patients <50 years.

Ambulatory ECG monitoring: do a 24-h recording if atrial fibrillation is suspected and the standard ECG shows sinus rhythm. If 24-h recording is normal consider an 8-day recording.

Intracerebral haemorrhage

Intracranial arteriography: if suspected vasculitis, aneurysm, arteriovenous malformation, cavernoma

Subarachnoid haemorrhage

See Chapter67.

Cerebral venous sinus thrombosis and venous infarction

• Need to consider the diagnosis from the history (headache, vomiting, seizures, focal neurological deficits) and then specifically ask for CT venography or MR venography to confirm.