Before you decide whether he would be suitable for thrombolysis and/or thrombectomy you need to be able to interpret his CT brain scan.
Have a look at some CT brain scans and select Yes or No to each question.
CT scans: by Professor Andrew Farrall is licensed under CC BY-NC-SA 4.0
1.1 Is this CT scan normal? – Yes – Correct, there is no evidence of any abnormality.
1.2 Would this patient be suitable for thrombolysis or thrombectomy? – Yes – Correct, if the patient is within a few hours of a clinical stroke, a normal CT is compatible with a hyper-acute ischaemic stroke.
2.1 Is this CT scan normal? – No – Correct, there is an large area of established infarction on the patient’s Right hemisphere. The abnormal area is markedly hypodense (darker) with well defined edges.
2.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the changes are not compatible with a hyper-acute infarct, but rather a well established one. Treatment would be ineffective in this situation.
3.1 Is this CT scan normal? – No – Correct, there are early changes of ischaemia on the patient’s Left hemisphere. The sulci and cortex are less distinct than on the normal right side.
3.2 Would this patient be suitable for thrombolysis or thrombectomy? – Yes – Correct, the changes are compatible with ischaemia with onset in the last 4-6 hours.
4.1 Is this CT scan normal? – No – Correct, there is a large area of high density in the patient’s right hemisphere.
4.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the high density (white) is due to intracerebral bleeding. This is an absolute contraindication to thrombolysis or thrombectomy.
5.1 Is this CT scan normal? – No – Correct, there is a large area of high density over the patient’s left hemisphere. This is causing midline shift to the right.
5.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct the high density (white) is due to recent subdural haematoma. This is an absolute contraindication to thrombolysis or thrombectomy.
6.1 Is this CT scan normal? – No – Correct, there is an area of high density in the patient’s left hemisphere surrounded by an area of abnormal low density (darker) brain.
6.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, these appearances are of a brain tumour with surrounding swelling.
7.1 Is this CT scan normal? – No – Correct, there is an area of high density in the patient’s right cerebellar hemisphere.
7.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the high density (white) is due to recent intracerebral haematoma (white arrow). This is an absolute contraindication to thrombolysis or thrombectomy.
8.1 Is this CT scan normal? – No – Correct, there is a small area of high density (white) in the patient’s left hemisphere.
8.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the high density (white) is due to recent intracerebral haematoma (white arrow). This is an absolute contraindication to thrombolysis or thrombectomy.
9.1 Is this CT scan normal? – No – Correct, the sulci are normally just filled with cerebrospinal fluid and appear dark. In one of the sulci on the patients left side there is a line of high density.
9.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the high density (white) is due to recent subarachnoid bleeding (white arrow). This is an absolute contraindication to thrombolysis or thrombectomy.
10.1 Is this CT scan normal? – No – Correct, there is a large area of established infarction on the patient’s left hemisphere. The abnormal area is markedly hypodense (darker) with well defined edges.
10.2 Would this patient be suitable for thrombolysis or thrombectomy? – No – Correct, the changes are not compatible with a hyper-acute infarct, but rather a well established one (white arrows). Treatment would be ineffective in this situation unless the patient’s new symptoms suggested they were having a stroke in their right hemisphere or brainstem or cerebellum.
