Stroke mimic diagnoses presenting to a hyperacute stroke unit
Editor – The study that showed that access to magnetic resonance imaging (MRI) facilitated the diagnosis and management of stroke mimics1 strikes a parallel with another study evaluating MRI after a negative computerised tomography (CT) scan.2 In that study, as many as 11.5% of patients who had a non-diagnostic CT scan after presenting with atypical stroke symptoms were subsequently shown to have subacute infarcts when MRI was performed within 24 hours of the negative CT scan.2 These observations are strong arguments for an MRI-first policy along the lines demonstrated in a recently reported ‘real world’ study.3 In that study, among 314 patients with suspected stroke who were screened solely by MRI, 73 proceeded to intravenous thrombolysis. Thanks to a concurrent quality improvement (QI) strategy, door-to-needle time (DNT) significantly improved during the three phases of implementation of the MRI-first policy such that median DNT amounted to 83 minutes, 68 minutes and 54 minutes in phases I, II and III, respectively (p<0.001). Exceptions to MRI-first included contraindications to MRI (one patient) and poor general condition (two patients).
The QI process included pre-notification by the emergency medical service, limiting the MRI sequence and introduction of a rapid examination tool.3 The disadvantage of MRI being more time consuming than CT scanning can be mitigated by applying novel strategies to reduce the time taken by high computation processes, such as diffusion-weighted imaging. High angular resolution diffusion imaging is one such strategy. In theory, this strategy is capable of reducing computation time by about 50% without any reduction in result quality.4
Conflicts of interest
The author has no conflicts of interest to declare.
- © Royal College of Physicians 2017. All rights reserved.
References
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- Dawson A
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- Hammoud K
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- Sakamoto Y
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- Loro NF
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