2. How we diagnose Brain Attack

As soon as a brain attack patient arrives in the triage or on receiving call for such patient our Brain Rescue team is activated immediately. The ability to pinpoint the precise location of a brain attack and determine the extent of damage is of critical importance in making treatment decisions during an brain attack emergency. Based on symptoms and findings on examination our “Brain Rescue” team quickly determines whether the brain attack is an ischemic event or a hemorrhagic event so that appropriate medical therapy can be started without delay. To obtain diagnostic information, it is likely that several of the following diagnostic studies will be performed during an evaluation for brain attack.

Computerized Tomography (CT) Scan: CT scan is generally the first diagnostic test done after a patient with a suspected stroke arrives in the emergency room. This test rapidly distinguishes between an ischemic or hemorrhagic stroke and involves the use of low-dose x-rays to visualize the brain.

CT Angiography (CTA): A CT scanner can obtain an angiogram as well. However, an injection is required for a CTA so that the injected material (contrast dye) flowing through the brain arteries can be scanned, thereby producing a picture of the blood vessels. This study demonstrates a three-dimensional anatomical view of the cerebral blood vessels and detects any abnormality in the blood vessels like blockage of the blood vessel by a blood clot or aneurysm (ballooning of a weak vessel). We prefer doing CTA in all brain attack patients who come to us within 12 hours of symptom onset, so that site of the occlusion can be determined. In cases of large blood vessel occlusion we take the patient in the endovascular lab where angiography of brain vessels is done (like coronary angiography) and clot busting drug can be injected directly in the clot itself.

CT Perfusion Imaging : CT Perfusion images enable us to determine the extent of the brain damage already done as well as extent of the tissue which can still be salvaged. This helps us in deciding right treatment modality like intravenous or intra-arterial thrombolysis (injecting clot busting drug directly in the clot itself) or mechanical removal of the clot.