Deans' stroke musings: DOUBT Study Clarifies Role of MRI for TIA or Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, October 5, 2019

DOUBT Study Clarifies Role of MRI for TIA or Stroke

Your action point on this is to make damn sure you have all the classic symptoms, lost sensation, slurred speech, lack of movement on one side, dropped mouth. You don't want to be classified as too good to treat.

Every single stroke coming into your stroke hospital should have a protocol to follow. There is never a stroke that is too good to treat. You never magically recover from a stroke. Your doctor should never have to make a subjective decision. You have an objective damage diagnosis(The NIH Stroke Scale is not objective so we have a problem right from the start.). What should follow directly from that is a stroke protocol to remove the clot or stop the bleeding and then a protocol to stop the neuronal cascade of death or the hemorrhage cascade of death. This is so fucking simple, why can't it be done? Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?

DOUBT Study Clarifies Role of MRI for TIA or Stroke

Diagnosis changed for 30% of study participants after MRI findings

by Zeena Nackerdien PhD, CME Writer, MedPage Today October 4, 2019

Study Authors: Shelagh B. Coutts, Francois Moreau, et al.; Margy E. McCullough-Hicks, Gregory W. Albers
Target Audience and Goal Statement: Neurologists, radiologists, emergency department physicians, hospitalists, internists
The goal of this study was to establish the frequency of acute infarct defined by diffusion restriction detected on diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI).
Question Addressed:

What was the rate of stroke defined by diffusion restriction detected on MRI scans among patients with low-risk suspected transient ischemic attack (TIA) or minor stroke presentations?

Study Synopsis and Perspective:
Patients with low-risk suspected TIA and minor stroke had a higher-than-expected rate of true ischemia on MRI, suggesting neurologists' clinical assessment alone did not reliably produce the correct diagnosis, researchers for the prospective observational DOUBT study reported.

Action Points

Patients with low-risk suspected transient ischemic attack (TIA) or minor stroke had a higher-than-expected rate of true ischemia on MRI, in a prospective, observational, international, multicenter cohort study, suggesting neurologists' clinical assessment alone did not reliably produce the correct diagnosis.
Realize that these data argue that an MRI is a necessary component of clinical evaluation in virtually all patients presenting with symptoms suggestive of a TIA or minor stroke, including those with short-duration motor or language deficits or persistent low-risk neurologic symptoms.