For this week’s blog I am going to look at a patient’s diagnostic pathway, in particular a patient who is thought to have suffered from a stroke. Diagnostic Imaging plays a large part in the diagnosis of a stroke as it is quick and can show a lot of detail for diagnostic purposes quickly. This topic may aid my whilst on placement – possibly as a case study – which would be part of my Intermediate diagnostic imaging studies module, also in the patient health and wellbeing module our groups theme is also stroke, so I could perhaps use this as a reflection within my work.
There are three types of strokes that may affect a patient:
- An ischemic stroke.
- This type of stroke occurs when there is an obstruction (clot) within a blood vessel (American Stroke Association, 2014) and occurs in around 87% of stroke patients. (American Stroke Association, 2014)
- A haemorrhagic stroke.
- This type of stroke occurs when a weakened blood vessel ruptures and bleeds into the brain (American Stroke Association, 2014).
- A transient ischemic attack (TIA)
- This type of stroke is caused by a temporary blockage (clot) (American Stroke Association, 2014) and are usually warnings of a future Ischemic stroke (Stroke Association, 2014) the symptoms are usually temporary and last for around 24 hours; the blockage either moves or dissolves.
The effects that occur after a stroke can be very debilitating and can sometimes be fatal, depending on the location of the stroke in the brain and how much brain tissue is affected. If the stroke occurs on the left side of the brain – it will be the right side of the body that will be affected along with possible memory loss, slowing down of motor functions and speech and/or language problems. If the stroke occurs on the right side of the brain – it will e the left side of the body that will be affected, along with possible memory loss, vision problems and change of behavioural style. If the stroke occurs within the brain stem – both sides of the body can be simultaneously affected, also stopping motor functions such as speaking (Stroke Association, 2014).
There are certain risk factors within an individual than can increase the likelihood of a patient experiencing a stroke such as, high blood pressure, smokers, diabetic patients, heart disease, age and gender can also impact the likelihood of a stroke, also race and ethnicity (National Heart Lung and Blood Institute, 2014), Symptoms of a stroke tend to develop quickly but can also take hours or days to develop with a TIA the symptoms can last from around 2 to 24 hours (Stroke Association, 2014). Some stroke symptoms include:
- Sudden weakness.
- Speech/vision difficulty.
- Breathing difficulty.
- Loss of consciousness. (National Heart Lung and Blood Institute, 2014)
Within the United Kingdom, there is a lot of campaigning to make the population aware of strokes. The national FAST campaign was introduced to educate the population on strokes and what to look for in an individual.
When stroke strikes, act F.A.S.T
(NHS choices, 2014)
- Face: Has their face fallen on one side? Can they smile?
- Arms: Can they raise both arms and keep them there?
- Speech: Is their speech slurred?
- Time: Time to call 999, if you see any single one of these signs. (NHS choices, 2014)
As with the acronym FAST timing is essential when dealing with a stroke patient, a stroke is classed as a medical emergency (The Internet Stroke Centre, 2014).
When a patient is thought to be experiencing a stroke 999 should be dialled immediately, the first medically trained individuals that the patient should occur within the pathway are paramedics. The paramedics will then transport the patient to the emergency department where a doctor should be waiting the patient’s medical history will be obtained along with a physical examination of the patient and blood tests. When a patient is suffering with a suspected stroke there are a multitude of radiographic examinations that may be undertaken:
- A brain Computed Tomography (CT) scan – this is usually the first diagnostic examination that the patient undergoes as soon as a stroke is suspected, it is quick, very detailed and can show bleeding in the brain or damage to the brain along with other pathologies that may be present resulting in the symptoms the patient is showing.
- A Magnetic Resonance Imaging (MRI) scan – this can be used additionally to or in place of a CT scan. An MRI scan can detect changes in the tissue of the brain.
- A CT Arteriogram or an MRI Arteriogram – this test can show the larger blood vessels in the brain and can give information of the location of the blood clot.
- A Carotid Ultrasound – this examination can show weather the carotid arteries are blocked or narrowed (National Heart Lung and Blood Institute, 2014).
With the use of radiographic diagnostic examinations, patients with suspected strokes can quickly be examined, detailed images of brilliant diagnostic quality can be obtained which can be used to identify if the patient has experienced a stroke, where it is located and what type of stroke has occurred. These images allow a correct diagnosis to be made extremely quickly; this quick diagnosis can allow sometimes life saving medication to be provided to the patient immediately which may improve their quality of life following a stroke.
American Stroke Association, 2014. American Stroke Association. [Online] Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp [Accessed 7 November 2014].
National Heart Lung and Blood Institute, 2014. National Heart Lung and Blood Institute. [Online] Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/signs.html [Accessed 7 November 2014].
NHS choices, 2014. Stroke: F.A.ST. [Online] Available at: http://www.nhs.uk/actfast/Pages/stroke.aspx [Accessed 7 November 2014].
Stroke Association, 2014. Stroke Associatione. [Online] Available at: http://www.stroke.org.uk/about/types-stroke [Accessed 7 November 2014].
The Internet Stroke Centre, 2014. The Internet Stroke Centre. [Online] Available at: http://www.strokecenter.org/patients/stroke-diagnosis/how-a-stroke-is-diagnosed/ [Accessed 7 November 2014].