stroke question.

section4

hi all, does anyone know what the procedure is in ireland if you have a stroke.

do you get an MRI scan in every case after you have the stroke.

and does this help to diagnose vascular dementia post stroke.

KittyeeTrix

section4 wrote: »

hi all, does anyone know what the procedure is in ireland if you have a stroke.

Let me tell you of my experience of what happened to my mother last April when she suffered a stroke. Her common carotid artery(main artery bringing blood from heart to brain) was fully occluded or blocked.
She went to the casualty dept at about 1pm on a sunday, I didn't discover she was in the hospital until 8pm and went to see what was happening.
She had been having difficulty speaking at this point for 4 days. We sat in the waiting room until 1am that morning when she was finally given a cubicle, some 12 hours after she had first arrived at the casualty dept. We then were shunted from cubicle to chairs in a hallway back to another cubicle back to another waiting area and finally at 8am she was taken to a room where she saw a doctor. At this point she had been almost 19 hours in the casualty department. The doctor told us she seemed to be having some neurological event, at this point I too was one the verge of a neurological event myself!!!!!
He ordered an MRI at about 9am, she was then put on a guerney and spent the best part of the Monday out in the main waiting area of the casualty with 4 other people on guerneys to wait for her MRI. At this point they knew she had had a stroke.!!!!!
She had to wait a further 7 hours for the MRI until 4pm. CRAZY!!!!!
She finally got the MRI which showed up substansial damage to the parietal area of her brain, they were amazed that she was as coherent as she was due to the extent of damage found....
Obviously at that point it was clear she was to be admitted but of course came the wait for a bed on the ward..
We had to wait until 10pm that night for a bed, it was awful knowing that she was in the middle of an "evolutionary stroke" (ongoing damaging type stroke) and be in the middle of a packed casualty dept as our lives seemed to collapse around us!!!:mad:
Finally she was seen on Tuesday by the main stroke consultant, two days after going to casualty and after tests he decided she needed surgery to remove the full blockage from the artery. He gave her a 50-50 chance of surviving the surgery, thankfully she survived and is now doing well. Her speech is still very bad and could have been better if seen earlier.
There is a drug that can be given but only in the immediate hours after a stroke is suspected. Hard to prescribe the drug though when it takes almost 19 hours to see a doc in Ireland's casualty
She had numbness and weakness again in her right arm and fingers some 6 months after the first event.
She went straight to casualty as I had told her to do. I was at lectures and didn't find out for some 4 hours after she had been sitting in the casualty again.
I had to bang at the triage door and draw her past stroke history to the nurses attention and they called her in within half an hour, thankfully it was only nerve damage from the last stroke. I mean, good god above, how is a woman left out in casualty waiting room with her past history with people who have injuries like breaks, sprains. I understand everyone has to wait and the system is buckling under the pressure but strokes can kill quietly and quickly, or leave you with serious degicits which cannot be regained due to the damage to the brain as a result of oxygen deprivation.
My mum is barely able to communicate and could have been left there for another 12 -20 hours again whilst all the time having a stroke..
It's frightening.
Sorry for the rant,
In answer to your question, yes you do get an MRI but not necessarily a speedy one!!!!

cgc5483

fluffyorganic1 wrote: »

There is a drug that can be given but only in the immediate hours after a stroke is suspected. Hard to prescribe the drug though when it takes almost 19 hours to see a doc in Ireland's casualty

Hi fluffyorganic. Glad to hear that your mother is doing well. Unfortunately Ireland is not a good place to have a stroke despite being a country where heart disease and stroke are responsible for over 1/3 of all deaths. The main drug you are probably refering too is tPA (tissue plasminogen activator) which basically functions to dissolve the clot but must be given within 3 hours or so. However, it is only suitable for ischemic strokes i.e. blood clots blocking arteries and not haemorrhagic strokes. The MRI is essential for diagnosing the type of stroke and so unfortunatley in Ireland it is extremely rare that a patient presents at a hospital and undergoes a MRI within 3 hours. I've talked to doctors who have worked in Neurology depts in Ireland and have never actually given tPA to a patient. I've also talked to a neurologist who works in Seattle, US where the percentage of stroke patients who receive tPa is in the region of 40-50%, it can be done!!

KittyeeTrix

cgc5483 wrote: »

Unfortunately Ireland is not a good place to have a stroke despite being a country where heart disease and stroke are responsible for over 1/3 of all deaths.

It is crazy how stroke victims can be left outside in casualty waiting rooms when speed is a critical factor in the care of a stroke victim. Especially in a country like Ireland where we have a high incidence of strokes

The main drug you are probably refering too is tPA (tissue plasminogen activator) which basically functions to dissolve the clot but must be given within 3 hours or so.

That was the name of the drug I had read about following my mum's stroke. No chance of getting it in Ireland!!!:mad:

The MRI is essential for diagnosing the type of stroke and so unfortunatley in Ireland it is extremely rare that a patient presents at a hospital and undergoes a MRI within 3 hours. I've talked to doctors who have worked in Neurology depts in Ireland and have never actually given tPA to a patient.

It does seem to matter which country you live in regarding your care with regards a stroke, like you said, Ireland is extremely lacking. Sure, it's the same situation with regards the sufferers of Cystic Fibrosis. It's enough to get you out protesting outside the offices of the HSE and the Dail

DrIndy

CT is enough to diagnose a stroke - MRI can be used if looking for a very small area or if there is any uncertainty regarding this. In reality - CT is used to outrule a bleed in the emergency setting which is the biggest reason not to give tPA to breakdown a clot.

MRI is in fact not as sensitive for blood as CT is. However it will be better at defining a stroke or if it is something else.

The new protocol is to give thrombolysis (clotbusting drugs) within 4.5 hours of an ischamic stroke (caused by a clot). However this is not funded across all hospitals in ireland and there needs to be a large team of neurologists/ stroke consultants available to make this work as well as a well prepared XRay department. Protocol for thrombolysis is CT, NOT MRI.

If there is ANY uncertainty regarding this time frame - people become very cautious as giving it late can actually make things worse.

Hope this helps - specifics regarding why your relative in particular is getting a particular scan is best discussed with the team.