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April
21,
2009 -- 5:15am EDT
CT Scans for Strokes
In
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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