Utilization of Emergent Magnetic Resonance Imaging in the Diagnosis of Acute Ischemic Stroke

Utilizing an emergent magnetic resonance imaging (MRI) pathway for emergency department patients with acute onset of stroke-like symptoms allows for optimization of acute ischemic stroke treatment. Emergent MRI increases the percentage of patients administered intravenous tissue plasminogen activator (IV tPA) and minimizes stroke-related long-term disabilities. MRI also reduces the overall cost of stroke-related care by (1) preventing unnecessary IV tPA administration and its associated hospital costs and (2) facilitating faster stroke etiology work-up and treatment plan initiation to reduce hospital length of stay. The primary purpose of this article is to summarize two hospitals’ experience utilizing an evidence-based emergent MRI pathway for patients presenting to the emergency department with stroke-like symptoms who may be IV tPA eligible. Secondary purposes are to describe (1) emergent MRI pathway challenges with implemented mitigation strategies and (2) case examples (wake-up stroke; mild stroke-like symptoms with acute ischemic stroke confirmed by MRI). • Clinicians support utilization of emergent MRI for ED patients presenting with stroke-like symptoms. • Emergent MRI can increase the percentage of patients treated with IV tPA and minimize long-term stroke disabilities. • Emergent MRI reduces cost of stroke care by preventing unnecessary IV tPA administration and its associated hospital costs. • Emergent MRI facilitates faster stroke etiology work-up and treatment plan initiation, which can reduce LOS. • Utilizing emergent MRI to diagnose AIS poses challenges mitigation strategies can be implemented.