Stroke is a condition that requires both emergency and long-lasting treatment due to various symptoms, multiple types of disease, and broad risk groups. Modern healthcare organizations develop different strategies for patient management, including diverse imaging and treatment operations, and track the outcomes to evaluate their interventions’ efficiency. Indeed, Dr. Misulis described several scenarios where the specific screening and treatment strategies were selected based on the diagnosis type – hyperacute stroke, left MCA infarct, dissection-caused stroke, ICH, and TIA (Best Doctors, 2013). Stroke addressing requires practitioners and care providers to be educated on CT, stroke coordinator use, laboratory testing, and emergency screening, and make quick and evidence-based decisions (Zerna et al., 2018). This paper aims to discuss the imaging and treatment strategies for managing patients in acute stroke therapy, based on scenario one provided by Dr. Misulis.
People increase their predisposition to stroke by leading an unhealthy lifestyle, developing hypertension, hyperlipidemia, and having chronic conditions such as diabetes. Such patient history is described in Dr. Misulis’ scenario one, where the 48-years old female presented with acute onset of right hemiparesis and aphasia (Best Doctors, 2013). The condition is an emergency, and the patient was delivered to the emergency unit within half an hour since her colleagues noticed the onset. The quick examination and diagnosis are beneficial for the outcomes because it allows doctors to identify the precise disease and prevent the conditions’ worsening. In the scenario, hyperacute stroke was diagnosed through the right-hand neurological assessment and the brain CT. The choice is rational because it is based on the patient history of hyperlipidemia and is appropriate for examining aphasia (Broocks et al., 2019). As the examination was completed earlier, 3 hours since the onset, the client immediately received tPA.
Another crucial imaging necessary to identify the causes of hyperacute stroke is a CT angiogram which provides detailed information about the brain’s arteries performance and helps identify other treatment strategies. In Dr. Misulis’ scenario, the procedure displayed that the patient had severe left internal carotid artery and distal thrombus in the middle cerebral artery (Best Doctors, 2013). An angiogram is optimal for imaging the stroke because it enables medical workers to narrow the treatment choices and identify the best practices for efficiently influencing problematic areas (Zerna et al., 2018). The further treatment included stenting for left ICA stenosis due to the difficulty reaching the middle arteries.
The described intervention was both intravenous and intra-arterial, yet the modern research proved that there is no need for using both strategies simultaneously. It is essential to consider the timing when selecting the proper treatment because the intravenous tPA must be excluded in the case if more than 3-4 hours have already passed (Flint et al., 2020). Furthermore, Flint et al. (2020) concluded that “tPA independently predicted improved long-term outcome along with EST recanalization” (p. 2700). Consequently, the intervention choice in the scenario can be considered beneficial for patient treatment and addressing the stroke’s emergency.
Hyperacute stroke is the type of condition that requires quick and efficient imaging and treatment; therefore, the actions performed by the healthcare providers must be evidence-based and well-evaluated. The timing was a crucial factor in the given scenario as the patient was delivered to the emergency room in less than an hour since the onset. The primary examination was based on the client’s history and visible symptoms, and further screening, such as a CT angiogram, served to identify the causes and areas of stroke. The intravenous and intra-arterial interventions took place in the scenario; however, including both was not proven to be necessary for addressing hyperacute stroke.
Best Doctors. (2013). Global Grand Rounds: Acute stroke therapy presented by Karl E. Misulis, MD, PhD [Video]. YouTube. Web.
Broocks, G., Rajput, F., Hanning, U., Faizy, T. D., Leischner, H., Schön, G., & Flottmann, F. (2019). Highest lesion growth rates in patients with hyperacute stroke: When time in the brain particularly matters. Stroke, 50(1), 189-192. Web.
Flint, A. C., Avins, A. L., Eaton, A., Uong, S., Cullen, S. P., Hsu, D. P., Edwards, N. J., Reddy, P. A., Klingman, J. G., Rao, V. A., Chan, S. L., Hartman, J., Zrelak, P. A., & Nguyen-Huynh, M. N. (2020). Risk of distal embolization from tPA (tissue-type plasminogen activator) administration prior to endovascular stroke treatment. Stroke, 51(9), 2697-2704. Web.
Zerna, C., Thomalla, G., Campbell, B. C., Rha, J. H., & Hill, M. D. (2018). Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke. The Lancet, 392(10154), 1247-1256. Web.