If facts and figures are looked at carefully then it can be said that in U.S less than half of patients with acute stroke symptoms did not receive a brain scan within recommended guidelines. This is coming from the hospitals who are actively participating in a national quality improvement program, so rates in non-participating hospitals may be even worse. Timely diagnosis and treatment is essential to increase the chances for recovery in the stroke patients. While significant strides have been made to improve the response time of caregivers, a critical step in the process imaging of the brain to determine the nature of the stroke is still occurring too slowly at too many hospitals.
‘Time is brain’ is the simple mantra in stroke care but in U.S only 41.7 percent of stroke patients undergo brain imaging within the recommended 25 minutes of their arrival at a hospital. It also found that certain individuals, including people with diabetes, those over 75 years of age, women, those that do not arrive by ambulance, non-whites, and those with certain cardiac conditions were less likely to receive a timely brain scan. An ischemic stroke is death of an area of brain tissue (cerebral infarction) resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery most commonly a branch of one of the internal carotid arteries.
Commonly, blockages are blood clots (thrombi) or pieces of fatty deposits (atheromas, or plaques) due to atherosclerosis. Another common cause of ischemic strokes is a lacunar infarction. In lacunar infarction, one of the small arteries deep in the brain becomes blocked by a mixture of fat and connective tissue—a blood clot is not the cause. This disorder is called lipohyalinosis and tends to occur in older people with diabetes or poorly controlled high blood pressure. Imaging the brain is an essential tool in the diagnosis of a stroke and determines which treatment option physicians will pursue.
The clot-busting drug tissue plasminogen activator (tPA) can restore blood flow and improve clinical outcomes. However, this drug cannot be used when the symptoms are instead caused by a ruptured blood vessel in the brain. Furthermore, in order for tPA to be most effective it must be administered as soon as possible and within three hours of the onset of symptoms. It is therefore essential that physicians are able to “see” what is occurring in the brain, and quickly. Delays in diagnostic imaging can translate into missed or delayed treatment as well. Hence time plays a vital role and should be respected.