Tag Archives: university health network

CNA2016

When Seconds Count

Strokes.

They happen when the blood that is circulating within the brain is cut off or reduced in an area resulting in a loss of oxygen to that part of the brain. If not treated right away the brain can die.

Thanks to nuclear medicine, doctors can better assess and treat stroke patients, saving lives.

With a stroke, every second counts.  Neurons or nerve cells are lost at a rate of 1.9 million per minute when the brain is deprived of oxygen. The loss of these and other key brain transmitters, or synapses leads to accelerated aging in the brain.

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(Chart Courtesy of Dr. Timo Krings, Head of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital & University Health Network)

Dramatic treatment is required to save a patient’s life, everything has to move rapidly.

“2:00am: I was called for a stroke at the hospital. By 2:20 the team was at the hospital and by 2:40 we had removed the blood clot and the patient was off the operating table,” states Dr. Timo Krings, Head of Neuroradiology, University Health Network, Toronto Western Hospital.

From initial imaging to opening the blocked blood vessel and restoring blood flow happens in just a matter of minutes.

The proper diagnosis and successful treatment of strokes is thanks to a branch of Radiology known as Interventional Neuroradiology.

Interventional radiology involves a uses modern Nuclear Magnetic Resonance Imaging or Computed Tomography to identify where the blockage is within the brain and its size.

As Dr. Krings points out, imaging plays a major role in proper diagnosis and treatment.

“The imaging part is just as important because if we choose the wrong patient we can make things worse,” he explains. “If we open a vessel that was occluded for too long, l the dead brain won’t recover but the patient can be in danger because blood will rush to the dead brain, which can lead to a hemorrhage. Therefore the correct identification of right patients is as important as the treatment itself.”

Once the scan identifies a suitable patient, the treatment can begin.

Interventional Neuroradiology involves a minimally invasive procedure whereby an artery is punctured and small tubes known as catheters are placed into the blood vessels. In these small tubes, doctors can push in stents or devices into the blood vessels in order to treat the blood vessel from the inside out.

Symptoms you may be having a stroke: FAST

Face: Drooping eyelid or numbness on one side of your face. Vertigo or a whirling loss of balance

Arm: Unable to move your hand or arm on one side of your body

Speech: You can’t speak properly or speech is garbled

Time: Time is of essence and you should telephone 9-1-1 , if you think you may be having a stroke call 9-1-1

Dr. Krings points to a chain of stroke awareness and treatment. Beginning with the patient to be able to identify the symptoms of a stroke to emergency medical service (EMS) workers who can rapidly identify and take patients to stroke centers where emergency room (ER) teams can fast track patients into imaging.

“It’s a team effort between the patient, EMS, the ER doctor, neurologist, radiologist, dietician and rehab specialists. All of them have to play together to get the best outcome,” says Krings.

New Canadian guidelines call for the two pronged technique of imaging and interventional radiology as the best life-saving method to for the diagnosis and treatment of strokes.

 

CNA2016

For the Health of Your Lungs

According to the National Blood Clot Alliance, once every six minutes, someone dies from a blood clot and blood clots lead as the number one killer of new mothers during and after childbirth.

According to Massachusetts General Hospital, a pulmonary embolism or PE is a blood clot that develops in the blood vessels elsewhere in the body and travels to an artery of the lung. A PE is a blood clot once it has lodged itself in the lung and formed a blockage of the artery.

While there are numerous risk factors for developing a PE, the most common include:

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“Pregnancy puts a woman at increased risk of pulmonary embolism, so careful evaluation of pregnant patient is vital when they present with symptoms of chest pain and shortness of breath,” says Dr. Ravi Mohan, a radiologist and nuclear medicine specialist with the Joint Department of Medical Imaging for the University Health Network.

Left untreated mortality rates from pulmonary embolisms can be as high as 25 per cent. However, with the proper therapy, the rate of mortality decreases by nearly two-thirds to between two and eight per cent

One way to detect a potential clot in the body is known as a VQ or ventilation/perfusion scan. As Dr. Mohan points out, “nuclear medicine works from the inside out.”

In the case of a VQ scan two agents are given to the patient, one that looks at the airways (technegas) and the other to look at the blood vessels (Technetium 99m particles).  As the agents, decay they give off gamma rays.  These rays are in turn picked up by cameras, allowing physicians to detect abnormalities in the lungs.

These abnormalities are often seen as a decrease in the amount of perfusion or blood flow to a particular area in the patient while the ventilation or air flow will appear normal. It is this difference between the two parts of the tests that allows doctors to discover a blockage in the lung and thereby treat it.

Some of the symptoms may include.

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It is important to point out that not all clots will present with symptoms in the patients regardless of size or location of the blood clot.  “Patients may present with hypotension and shock in larger areas where as in patients with smaller blockages they have relatively few symptoms or no symptoms at all,” says Dr. Mohan

Treating pulmonary embolisms will vary from patient to patient but may include surgery, medications and oxygen therapy.