Stroke Case Studies

Strokes are caused by a temporary or permanent decrease in cerebral blood flow resulting from a stenosis or arterial occlusion (Montagu, et al., 2012). Despite being the predominant cause of acquired disability in England and Wales, a stroke can be both preventable and treatable (Lövblad, et al., 2015). The societal costs arising from stroke, including treatment and productivity loss, account for approximately 5% of total UK NHS costs, at around £8.9 billion a year (Saka, McGuire and Wolfe, 2008). Research shows, however, that with the correct treatment after a stroke, a patient can regain brain function and often independence, thereby reducing societal costs (Schellinger, et al., 2010).
Age, gender and family history are considered as non-modifiable
risk factors associated with stroke. Lifestyle habits however, such as smoking, large alcohol consumption and obesity can be modified to reduce risk of stroke. Table 1 shows common stroke symptoms (Tziotzios, et al., 2011).

Patients with suspected stroke require rapid access to optimal/suitable imaging to allow a swift and accurate diagnosis of stroke type, thereby initiating the necessary therapy in time (Society of Radiographers, 2015).
This decreases the patient’s risk of a recurrent stroke and helps to minimise morbidity and mortality, thus leading to a better patient prognosis (Brazzelli, et al., 2013).
Transient ischaemic attacks (TIAs) are brief neurological dysfunctions caused by brain ischemia, with symptoms usually lasting less than one hour. They indicate high vascular risk in patients; and up to 40% of stroke victims have suffered a prior TIA (Tziotzios, et al., 2011).
The author is going to evaluate the role of cross-sectional imaging in the clinical management of infarcted stroke, and the role of the radiographer within the patient’s pathway.
Non Imaging Tests

In the ambulance, the patient is screened using diagnostic tests to determine whether a stroke is suspected and to rule out hypoglaecemia (Royal College of Physicians, 2008).The hospital would be informed and the stroke specialist team alerted. After a Recognition of Stroke in the Emergency Room (ROSIER) test has been carried out, a request for brain imaging should be created (National Institute for Health and Care Excellence Guidelines,
2015).
Immediate Imaging

If the patient has indications for immediate brain scanning (see table 2) the scan should be performed within the next slot where possible and definitely within 1 hour (National Institute for Health and Care Excellence Guidelines, 2015). This is due to the contraindication to recombinant tissue plasminogen activator (rtPA), the approved treatment for ischaemic stroke, if the stroke is haemorrhagic. Guidelines suggest this treatment is given within three hours intravenously, the imaging and reporting therefore needs to be completed within this window of time (Royal College of Physicians, 2008). Patients with acute stroke but without indications for immediate imaging should be scanned within 24 hours of symptoms onset.