Monday, May 1, 2017

45 Minutes to diagnose a stroke. Don't miss the Window of Opportunity Artificial Intelligence Versus M.D. -

The 45 minute window of  a stroke. 

This is the time window before permanent changes occur in the brain after an obstruction of one or more arteries in your brain.

The time frame and liklihood of your receiving treatment during this period is not good. Time is of the essence and immediate recognition is imperative. If you are alone the odds get worse. 

The earliest signs may be double vision, or loss of vision, numbness, vertigo, weakness on one side, slurred speech, a sudden inability to speak.

Unless being proactive most patients and/or families are in denial when it occurs.  Chances are good that it will be one or more hours until you are at an emergency room.

The time log is critical as to when did the earliest symptoms begin?  The emergency department stop watch began as the patient came in through the doors, plus how long it took to get to the Emergency department.

Therefore it is imperative treatment begin as early as possible.  Televideo offers a significant decrease in time of stroke to treatment.  If properly used this modality offers great hope for better survival and decreased morbidity.

Telemedicine and EMS: The future is now

A time is coming whereby 'First responders', EMTs will have advanced training in treatment of stroke.  They will be able to start an IV and discuss their finding in real time with an emergency physician at the destination hospital. When indicated, the EMT will be able to begin intraveous treatment with clot-busting drugs as ordered by the emergency doctor.

At the least the ED will be prepared immediately when the patient arrives at the E.D.

Consumer technology can provide this, now, using commonly used video applications. It is a step in the right direction until a HIPAA application is applied.  Anyone using Facebook, Viber, Google Hangouts, Zoom, Livestream does this daily.

Another and important aspect of diagnosis when a patient arrives at the emergency department is proper diagnosis using CT or MRI Scans.

For example:

One evening last November, a fifty-four-year-old woman from the Bronx arrived at the emergency room at Columbia University’s medical center 
with a grinding headache. Her vision had become blurry, she told the E.R. doctors, and her left hand felt numb and weak. The doctors examined her and ordered a CT scan of her head.

A few months later, on a morning this January, a team of four radiologists-in-training huddled in front of a computer in a third-floor room of the hospital. The room was windowless and dark, aside from the light from the screen, which looked as if it had been filtered through seawater. The residents filled a cubicle, and Angela Lignelli-Dipple, the chief of neuroradiology at Columbia, stood behind them with a pencil and pad. She was training them to read CT scans.

“It’s easy to diagnose a stroke once the brain is dead and gray,” she said. “The trick is to diagnose the stroke before too many nerve cells begin to die.” Strokes are usually caused by blockages or bleeds, and a neuroradiologist has about a forty-five-minute window to make a diagnosis, so that doctors might be able to intervene—to dissolve a growing clot, say. “Imagine you are in the E.R.,” Lignelli-Dipple continued, raising the ante. “Every minute that passes, some part of the brain is dying. Time lost is brain lost.”

Strokes are typically asymmetrical. The blood supply to the brain branches left and right and then breaks into rivulets and tributaries on each side. A clot or a bleed usually affects only one of these branches, leading to a one-sided deficit in a part of the brain. As the nerve cells lose their blood supply and die, the tissue swells subtly. On a scan, the crisp borders between the anatomical structures can turn hazy. Eventually, the tissue shrinks, trailing a parched shadow. But that shadow usually appears on the scan several hours, or even days, after the stroke, when the window of intervention has long closed. “Before that,” Lignelli-Dipple told me, “there’s just a hint of something on a scan”—the premonition of a stroke.

Lignelli-Dipple pulled up a second CT scan, taken twenty hours later. The area pinpointed by the resident, about the diameter of a grape, was dull and swollen. A series of further scans, taken days apart, told the rest of the story. A distinct wedge-shaped field of gray appeared. Soon after the woman got to the E.R., neurologists had tried to open the clogged artery with clot-busting drugs, but she had arrived too late. A few hours after the initial scan, she lost consciousness, and was taken to the I.C.U. Two months later, the woman was still in a ward upstairs. The left side of her body—from the upper arms to the leg—was paralyzed.

For a radiologist and other physicians who read images pattern recognition become ingrained in their brain..a specific portion of their brain lights up on fMRI studies. If you want to learn more about it, read the entire article......

A.I. Versus M.D. - The New Yorker
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