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The diagnosis of the stroke is confirmed typically on brain imaging. And so the two brain imaging modalities that we'll use to confirm a stroke, preferably it's MRI. MRI is generally speaking, the gold standard way to confirm it and there's something called diffusion weighted imaging where we see sort of a bright white dot where the stroke is at. It is black and white. It's very clear and that's what we see. There are some people who can't get MRIs because they have a metal in their body. MRI is a big magnet, or if they have a pacemaker. In those cases we use CT. CT is less sensitive, but frequently we do eventually see the stroke on the CT and what we see on CT is an area of low density where the stroke is at. There's a little bit of swelling and more water in that part of the brain is it swells up when it's injured and we can see that looks at less dense than the rest of the brain. With our current state of the art imaging techniques, specifically MRI, we can confirm the diagnosis of a stroke in someone who's had one in well over 90% of cases.
The diagnosis of the stroke is confirmed typically on brain imaging. And so the two brain imaging modalities that we'll use to confirm a stroke, preferably it's MRI. MRI is generally speaking, the gold standard way to confirm it and there's something called diffusion weighted imaging where we see sort of a bright white dot where the stroke is at. It is black and white. It's very clear and that's what we see. There are some people who can't get MRIs because they have a metal in their body. MRI is a big magnet, or if they have a pacemaker. In those cases we use CT. CT is less sensitive, but frequently we do eventually see the stroke on the CT and what we see on CT is an area of low density where the stroke is at. There's a little bit of swelling and more water in that part of the brain is it swells up when it's injured and we can see that looks at less dense than the rest of the brain. With our current state of the art imaging techniques, specifically MRI, we can confirm the diagnosis of a stroke in someone who's had one in well over 90% of cases.
We'll get an MRI and an MRI, which is by far and away our most sensitive tool for detecting stroke. It comes in two parts. The first is the MR image itself, the MRI, and that's going to show us the brain. And on that, that's about a 30 to 45 minute test in a big tube. So you have to sit still to get a good picture. But keep in mind, MRIs are giant magnets, there's no radiation exposure. And again, we can see a pinpoint size stroke that we would never see with any other tool. On top of that we can see new strokes and old strokes. So there are different, basically a stroke within the first 10 days looks different than a stroke that's 30 days old, which looks different than a stroke that's four years old. So we can actually sort of differentiate between different ages of strokes, often not perfectly, but to a large degree. Number two, the second part of the MRI, something called an MR Angiogram. And the idea here is that actually we're looking at blood vessels of the brain. And actually blood vessels from the heart all the way up. And there's a few different ways for us to do that. So the most common way here at Tucson Medical Center is with an MR Angiogram. There is something called a CT angiogram, and there's also a carotid ultrasound and we're all sort of trying to answer of similar questions with each test. With an MR Angiogram, you're in the big tube and you're just sitting still and you don't have to do anything. The people who are doing the MRI can essentially adjust the MRI to, instead of looking at stationary tissue, they will look at moving things. So everything that's moving gets picked up and the things that are stationary you can't see. And so all of a sudden the arteries light up and you can see them very well.
Sometimes an MRI isn't possible or for some reason the MRI is inadequate. So in those cases we'll use something called a CT angiogram. A CT angiogram is where they actually inject dye into your arm and move you through a CT scan. A CT scan is again is that big donut. It's very fast. It's probably a two to five minute study and basically as they're injecting the dye, they can see that dye move through your arteries and you move through that scanner as a dye moves through you. The last thing is something called the carotid ultrasound. The carotid ultrasound, you know you've got four pipes, so the carotid ultrasounds really sees the carotids very, very well. But the other arteries you don't see as well. So the carotid ultrasound can sometimes be a little bit limited and something we use to augment the other studies that we've had done. Beyond that we'll often be checking lab work, like I said earlier. So we're checking cholesterol screens. Again, paying very careful attention to your total cholesterol, the bad cholesterol called an LDL. We can get your blood sugars and those are the main tests that we're going to be ordering. The other things that sort of expect in the hospital, and these are actually very important parts of your hospitalization, are going to be rehab after someone has a stroke and they've got some deficits we know that sort of, my analogy is is that your brain is like the roots of a tree. Okay. If there's an area of damage, your brain cells are like roots. There are around there. And what they'll do is if you stimulate them, they'll grow around that area that they can't get water from anymore. They'll grow around that injury and they'll make up for it. But the key to doing that is early Rehab, early therapy, early exercise. So in the hospital, one of the most important things that we do is we get physical therapy, speech therapy, occupational therapy involved depending on someone's deficits from the stroke, and then try to get them into some type of rehab situation where they can continue to improve afterwards. So in summary, when someone comes into the hospital, one expect things to move really fast because time is of the essence. Number two, you're going to get a variety of scans all looking at sort of what's the cause of the stroke? Looking at your heart, looking at the arteries, and really carefully looking at the brain. And lastly, but frankly, most importantly is going to be the rehab aspect of your treatment.
When someone has a stroke, I emphasize this, it is crucial to get into the hospital. Let's talk about sort of what to expect once you're in the hospital. The first thing I would point out is if someone's having a stroke or you believe someone's having a stroke, the best way to get someone into the hospital fast, and again, the crucial thing here is time is brain. Fast is important, is a calling nine one one and using the emergency medical services, they are trained paramedics and EMTs are trained to recognize stroke and they will get you in fast. Once you're in the hospital, what should you expect to sort of have happen? The first thing is you come into the ER with a stroke. Usually, things are going to move very, very quickly and immediately, you'd have a blood draw done looking for any evidence of things that would provoke stroke, getting your cholesterol in your blood sugar, making sure that you're not anemic. And then initially a cat scan is generally the most common first test done. A cat scan is not the most sensitive test for stroke, but it can be done fast and efficiently and it actually, while it's not sensitive for ischemic stroke like we talked about before, it is actually very sensitive for hemorrhagic stroke and subarachnoid hemorrhage. After the CT scan is done and the blood work is done, often there's going to be the decision as to whether or not someone should get clot buster. And that's something that we'll talk about later. That decision has to be made very, very rapidly. And then often the person who's had the stroke is admitted to the hospital and will often stay for a day or two. During that hospital stay the question that the physician or the team is trying to sort of ask themselves is where did the stroke come from? And that's a crucial question to ask ourselves because that is going to dictate how we prevent another one from ever occurring. And so that'll involve basically evaluating you from here on up. They'll be doing an EKG, looking at your heart rhythm, looking for A fib. They'll often have you on continuous cardiac telemetry. Again, looking at the rhythm of the heart, looking for A fib or any other irregular heart rhythm that can provoke stroke. Often you will get an echocardiogram, and this is kind of like what they use, looking at an ultrasound, like what we use for pregnant women, but instead we can actually look at it through the sternum and look at the structure of the heart, looking at the heart function, looking at the valves of the heart.
An important thing to recognize are the signs and symptoms of stroke. It's critical to know the signs and symptoms of stroke because if you can't recognize it, you're not going to get someone into the hospital. And time is brain. And getting someone into the hospital as soon as possible is crucial. A nice acronym to remember for the signs and symptoms of stroke, which can be a little complex, is something called B.E.F.A.S.T. And what does B.E.F.A.S.T. stand for? Balance. Eyes. So first of all, you look at someone's balance. Are they able to walk a straight line eyes? Do they have any vision problems? Sudden vision loss in one eye or both eyes? F fast. F look at their face. Smile is their face symmetric and especially you're looking at, interestingly with a stroke, the stroke involves the lower half of the face generally. Okay, so we're not looking at the eyebrows and the eye movements, but we're looking at the lower half of the face. And so we asked him to smile. And you're looking at these folds on either side right here are the dimples. Nice and symmetric. If you're still not convinced, you can sometimes even count the teeth across to see how symmetric it is. But usually it's pretty obvious. Arm. Ask someone to lift out their arms straight out. And ideally what you'd do is have them hold their palms up and you're looking for weakness. If they're bringing their arm down or bring their arm across like this, that's a sign of a stroke. And then speech, have them repeat a sentence. Can they say it clearly? Are they able to repeat the sentence? And then if they can't do any of those things you want to look at the time. Again, I can't emphasize this enough. Time is critical. Time is brain. And the reason is that the stroke treatments that we have available in the hospital, the only FDA approved treatments are time sensitive. Intravenous clot-buster is only available within the first three hours after a stroke. And sometimes we'll give it longer, but the longer we wait, the less effective it is. So in recap, the signs and symptoms of a stroke can be nicely encapsulated in the acronym B.E.F.A.S.T. Balance, eyes, face, arm, speech. Look at the time.
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