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April 21, 2009 -- 5:15am EDT

CT Scans for Strokes
Aquilion CT ScannerIn today's Wall Street Journal, Thomas M. Burton discusses the controversy over the use of CT scans to diagnose and triage treatment for stroke victims in his article, "Doctors Push for More Scans in Stroke Cases".

It's an important topic, and one which Dr. Nick Hopkins, head of the Toshiba Stroke Center, discusses in more detail during our interview, posted in Angioplasty.Org's Imaging and Diagnosis Section.

Stroke has been called a "heart attack in the brain". If only it were that simple. A heart attack is caused by a sudden stoppage of blood to the heart -- the treatment: open up the blockage.

But strokes can have two different causes -- and the treatments for these two different types of stroke are totally opposite. An ischemic stroke, the "heart attack in the brain" type, is treated with clot-busting drugs, and/or a clot-retrieval device, threaded to the brain via a catheter, not unlike angioplasty.

But the second type of stroke is caused by an aneurysm or other type of bleeding complication. Giving a clot-buster in this situation would be disastrous.

Luckily, a CT scan of the brain immediately tells the physician which type of stroke the patient is having. And luckily again, CT scans can be done very quickly in an Emergency Department set up for this type of diagnostic procedure. Furthermore, as Dr. Hopkins points out, there's yet another advantage to the CT scan -- it also shows the viability of the brain tissue. If significant parts of the patient's brain tissue have died, attempting to reperfuse (increase circulation) in those parts may cause even worse complications, such as hemorrhage.

The controversy detailed in Burton's article is over official guidelines for the use of CT, with implications for reimbursement. I won't get into the details, because you should read his piece, but this is just one more issue where advances in imaging, being able to see, have profound implications for being able to treat.

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