In a community where socioeconomic status of majority of the population is low, and the diagnostic facility not readily accessible; with no government support and slow social welfare action.
Hi M.OMONIYI,
I think that brain imagery is helpful when specific treatment could be applied, and need differentiation between ischemic and hemorrhagic stroke.
How is organized the care system you are referring for patients after a stroke?
Cordially.
Ideally, people should have a CT scan as soon as possible after a CVA, as it is important to diagnose its origin and track the course of neurological changes in the days following stroke. Without a proper neurological assessment in the sub-acute stages, outcomes are liable to be far worse.
It is therefore vital that, if such facilities are not readily available, a person after CVA is transported as soon as possible to a facility that has such equipment.
Imaging should only be used in my opinion if there are the resources to act upon the findings. CT is I think more useful in the acute phase if you can get it, and cheaper than MRI.
According to our stroke protocol , all patients with CVA should have a CT on admission just to exclude hemorrhage. If within the time window (3 hours from onset) we inject rTPA, provided no contraindications. If past the window we start low molecular wt heparin till we Exclude cardioembolism. All patients then have MRI, MRA to determine any past strokes and identify intracranial vascular state. ECG, echo cardiography to exclude cardioembolic stroke. Carotid duplex for extra cranial vascular state. Full lab workout.
if proved cardioembolic we start anticoagulants.
if not, we give anti platelets, according to vascular status. And control risk factors.
It is important to have CT/MRI as soon as possible after stroke. This will help the Rehabilitation team to make an informed decisions about the care of the patient. As you may be aware, as Rehabilitation therapists, we attach so much importance to the highest possibility of the plasticity of the brain during early post-stroke. However, the nature and extent of the pathology could guide whether rehabilitatiob should start or not