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Strokes are one of the leading causes of death in many parts of the world. Consequently, it is essential to adopt procedures that lead to the accurate diagnosis of the condition. The CT scan is a primary mode of investigation of the disease. This report will determine its impact on the management of the condition within clinical and emergency settings.
Impact of CT scans on stroke diagnosis
A stroke is a condition in which one looses brain functions at a rapid rate owing to disruptions in blood supply in the cerebral region. The syndrome may result in physical symptoms, such as, the inability to control limbs on one side, uncoordinated speech, visual defects on one side of the body, pain, seizures, emotional inability, coma, loss of speech, muscle numbness, pneumonia, anxiety, or even death.
The latter effect may occur if the stroke persists for more than one day. All physical manifestations correspond to the part of the brain that the stroke affected. It should be noted that, during a stroke, clinicians can look out for symptoms, such as stiffness of the neck, convulsions and headaches, to diagnose the condition.
Since the effects of a stroke are dependent on the swiftness and response given, then it is essential to use a method of diagnosis that can be done quickly.
Therapeutic interventions depend on the stroke that clinicians identify. For instance, it may be thrombolytic, so this necessitates the use of anti- platelet therapy. Alternatively, it could be hemorrhagic, so this should lead to the use of agents like Nimodipine.
Early detection of the pathology of the stroke is essential in the therapeutic decision. The Computerized Tomography (CT) scan has assisted in the early identification of these pathologies, and thus facilitated timely treatment responses. If patients lack access to CT scanning technologies or other clinical detection methods, then they may get wrong treatment, which could lead to health deterioration.
The management of stroke patients has tremendously improved owing to the use of CT scans. Computerized Tomography scans assist in differentiating between the two key types of stroke; Ischemic or hemorrhagic. Hemorrhagic strokes emanate from burst blood vessels in the cerebral region while Ischemic strokes stem from the absence of blood flow in the same region.
Additionally, the scan can assist in location of which part of the brain the problem affects. It is also necessary to determine the severity of a stroke, and the CT scan also assists in this course of action. If the condition has ever occurred in the past, one needs to know the risk of future transient Ischemic attacks (a condition that mirrors symptoms of a stroke but reverses within 24 hours); CT scans assist in that process, as well.
Treatment methods for strokes are evidence-based. Therefore, clinicians ought to strive to make diagnoses that are as accurate as possible. Most modern methods used in detection lack the sensitivity and specificity of the CT scan. The CT scan aids in excluding or confirming the existence of a cerebral hemorrhage at an early stage. Consequently, clinicians can begin anti- platelet therapy on such patients if they find no hemorrhage.
Alternatively, blood pressure may be controlled, depending on the stroke subtype, if a clinician uses a CT scan. If medical facilities lack these technologies, then they might give patients anticoagulants when they have intracerebral hemorrhage, which is a serious mistake (Fiebach et al 530). Anticoagulants work by increasing the flow of blood, so they are inappropriate for a patient who already has a hemorrhaging problem.
There are conditions in which the CT scan is more useful than MRI scans or other detection methods. For instance, when a patient has a severe stroke and an immediate decision is imperative, then the easily-administered CT scan is superior to other methods. It can easily differentiate between the two key types of strokes mentioned earlier.
In fact, the short length of time required for the administration of CT scans explains why it is a superior method for patients with severe strokes. Before clinicians can administer thrombolysis drugs, they need to make a time-limited analysis, and the CT scan is quite useful for this purpose. Patients with low consciousness levels particularly rely on CT scans because this can contribute to the successful administration of treatment.
When treatment is necessary, certain physiological conditions are more effectively noted using CT scans than other methods. If the internal carotid artery possesses surgical stenosis, then a CT scan can be quite appropriate. Experts use the method for its specificity and sensitivity in this area. It provides an accurate visualization of plaque ulcerations or other defects on the arterial wall. Therefore, the method is critical in illustrating how the interior section of an arterial wall looks like.
The best application of a CT scan is in the detection of cerebral hemorrhage. The method has specificity of 89% and a sensitivity of 100%. Conversely, the MRI scan has a sensitivity of 81% and specificity of 100% (Nogueira et al. 870). As a consequence, the CT scan is more effective for hemorrhagic strokes.
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This advantage stems from the superior visualization of blood vessels. Therefore, if one has ruptured a blood vessel or an arteriovenous malformation exists, then the CT scan will reveal it quite clearly. This category of strokes can be quite detrimental if left untreated. The presence of excess blood in the brain often leads to pressure build up, and brain damage, so it ought to be corrected as soon as it arises.
A CT scan is also desirable in instances where patient movement may be difficult to control. The equipment will still read through movement, and thus give useful images. Furthermore, the technology can be used even when a patient contains an implanted medical device. Other scanning technologies like MRIs are too sensitive to patient movement and will react to the presence of medical devices in the bodies of stroke patients.
Scholars have carried out a number of case studies on the effect of CT scans on clinical outcomes, and most of them have demonstrated positive results. Goyal et al. (95) carried out one such study. The team wanted to find out whether CT scan appearance led to the improvement of time taken to recanalize patients in acute Ischemic strokes as well as in endovascular thrombectomy.
A patient with an Ischemic stroke undergoes treatment by recanalization of an occluded artery. Recanalization refers to the creation of new paths through a blockage in an artery. An institution may decide to use intravenous IV administration for treatment of acute Ischemic strokes. However, the latter path often leads to poor recanalization rates.
Conversely, one may use endovascular methods, which lead to high recanalization rates but low clinical outcomes. In order to determine the right treatment method, many institutions rely on baseline CT scans. The authors of the above case study went ahead and studied the effect of a favorable CT scan on the time it takes to recanalize. They found that if a CT scan score were less than or equal to 4, then a patient would not get positive outcomes from recanalization.
However, if the patient had a CT scan score of greater than 7, then they had better chances of benefiting from the recanalization. Additionally, if the CT scan illustrated that a patient had severe damage and a score of greater than 4, then they benefited from fast recanalization. The above study, therefore, shows that CT scans play a crucial role in boosting clinical outcomes for patients undergoing treatment.
Hill et al. (1612) also carried out research on how CT scans can enhance clinical effectiveness in the treatment of stroke. They focused on intravenous (IV) therapy as well as intra- arterial (IA) therapy for treatment of ischemic strokes. The authors explained that hospitals and patients spend a lot of resources on the administration of IV-IA therapy.
Therefore, it is always crucial to select the right patients first before taking them through this intensive procedure. Neuro- imaging, through CT scans, is an effective way of ensuring that clinicians select the right patients for treatment. In the analysis, they looked into the CT scores of 460 ischemic stroke patients. The authors compared the clinical outcomes of patients with unfavorable baseline CT scan readings to the ones with unfavorable and neutral scores.
They found that those individuals whose CT appearance was favorable, had a higher success rate during the treatment of the stroke (through IV-IA therapy) than those without an unfavorable outcome. Consequently, this research also proves that medical imaging using CT scans can aid in the selection of the right patients for treatment of the disease.
Limitations of the CT scan
CT scans have their limitations, as well; clinicians cannot diagnose Ischemic strokes unless these have occurred 6 hours before, which undermines the application of the method. The presence of blood clots or lesions principally cause Ischemic strokes. CT scans are not effective in visualizing these lesions, especially because the lesions could be secondary or acute.
Nonetheless, if early signs of ischemia already exist and more accurate methods of detection are unavailable, then clinicians may opt for the use of a CT scan. Statistics indicate that MRI scans have a sensitivity of 83% and specificity of 98% when assessing ischemic strokes. Conversely, CT scans only have a sensitivity of 16% and specificity of 96% when used for this same purpose.
CT scans cannot assist in understanding the symptoms behind complicated strokes. If a clinician is uncertain about the location of the stroke, then a CT scan cannot shed more light on it. In this circumstance, it would be more effective to rely on an MRI scan. The latter method provides more details of brain tissue than CTs.
CT scans support the treatment of patients with strokes by facilitating fast detection of the nature of the stroke. They are particularly useful when the concerned individual has a hemorrhagic stroke.
The technology also assists in selecting the right patients for treatment of ischemic stroke thus leading to more successful outcomes. Nonetheless, this form of medical imaging has its limits as it has low sensitivity when analyzing complex strokes or diagnosing ischemic strokes. Therefore, CT scans should be used to complement other imaging technologies and in the above-mentioned cases alone.
Fiebach, J, P Schellinger & A Gass. “Stroke Magnetic Resonance Imaging is Accurate in Hyper Acute Intracerebral Hemorrhage: A Multicenter Study in the Validity of Stroke Imaging”. Stroke 35.2(2004): 502-506. Print.
Goyal, Mayank, Bijoy Menon, Shelagh Coutts, Michael Hill & Andrew Demchuk. “Effect of Baseline CT Scan Appearance and Time to Recanalization on Clinical Outcomes in Endovascular Thrombectomy of Acute Ischemic Strokes”. Stroke 42(2011): 93-97. Print.
Hill, Micheal, Andrew Demchuk, T Tomsick, Y Palesch & J Broderick. “Using the Baseline CT Scan to Select Acute Stroke Patoents for IV-IA Therapy.” American Journal of Neuroradiology 27(2006): 1612-1616. Print.
Nogueira, R, A Yoo, F Buonanno, J Hirsch. “Endovascular Approaches to Acute Stroke: A Comprehensive Review of Studies and Trials”. American Journal of Neuroradiology 30(2009): 859-875. Print.