New Diagnosis and Treatment Options
The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is of critical importance in making treatment decisions during a stroke emergency. For instance, the physician must be able to quickly determine whether the stroke is an ischemic event (arising from a blocked blood vessel) or a hemorrhagic event (bleeding caused by bursting of a blood vessel) before the appropriate medical therapy can begin.
The Stanford Stroke Center is one of the few places in the country that has more than a dozen state-of-the-art brain diagnostic devices available to obtain in-depth information about a patient's status. These highly sensitive tools are of critical importance in diagnosing abnormalities that place a patient at high risk for stroke, such as a blocked blood vessel or the presence of an aneurysm or AVM.
To obtain complete diagnostic information, it is likely that several (but not all) of the following diagnostic studies will be performed during an evaluation for stroke or stroke risk.
- Computerized Tomography (CT) Scan is generally the first diagnostic test done after a patient with a suspected stroke arrives in the emergency room. It is used to quickly distinguish between an ischemic or hemorrhagic stroke. The test involves the use of low-dose x-rays to visualize the brain.
- Magnetic Resonance Imaging (MRI) is an advanced diagnostic tool that provides a high level of anatomic detail for precisely locating the stroke and determining the extent of damage. Due to its high level of sensitivity, MRI is considered especially useful when the stroke involves small blood vessels. The technology involves use of a strong magnetic field, and is performed in a special room free of metallic equipment. Recently, there have been great advances in the early detection of stroke using diffusion and perfusion weighted imaging. These techniques are currently available at Stanford.
- Magnetic Resonance Angiography (MRA) is a new noninvasive technology for imaging the cerebral blood vessels, which yields valuable information regarding collateral (alternative) blood vessels in the brain. Stanford has been a pioneer and leader in the development of this technique.
- Carotid Duplex Scanning is a noninvasive study to diagnose blockage in the carotid arteries. This technology involves recording sound waves that reflect the velocity of blood flow.
- Transcranial Doppler (TCD) is a new, noninvasive ultrasound procedure that allows the assessment of blood flow through the cerebral vessels via a small probe placed against the skull. TCD is a portable test, which can be performed frequently at the patient's bedside to follow the progress of medical treatment for stroke.
- Xenon CT Scanning is an imaging method that uses the inert gas xenon to measure blood flow in various brain regions.
- Radionuclide SPECT Scanning provides data on relative blood flow using the radionuclide Technetium99.
- PET Scanning, which measures brain cell metabolism, can determine if brain tissue is functioning even if blood flow to that area appears to be diminished
- Cerebral Angiography (angiogram) is a diagnostic study that requires injection of a contrast dye through a major artery (usually the femoral artery in the thigh) for evaluation of blood flow to the brain. This procedure is completed in Stanford's Cath/Angio lab. The procedure time is approximately two to three hours; bed rest for six hours is required after the procedure
- Transesophageal Echocardiography involves placing a flexible tube in the esophagus to directly image the heart.
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