Neuroradiology is a key component in a stroke emergency

Seconds count when someone has a stroke, but an accurate diagnosis can take time.

Thankfully, technology is constantly improving the speed and accuracy with which a Comprehensive Stroke team can find answers.

With both ischemic and hemorrhagic strokes, the patient must be carefully evaluated before the team comes up with a treatment plan. A clogged artery in a patient’s neck, for example, could make it impossible to remove a clot from the brain with a wire inserted through the leg. If there is any sign of bleeding in the patient’s brain, the team won’t be able to administer the clot-busting IV-tPA drug. And the team must find the source of the stroke so they can treat it and help the patient prevent future strokes.

To make the best possible decision as quickly as possible, UF Health Jacksonville’s Comprehensive Stroke Center includes fellowship-trained neuroradiologists. Facilities with less advanced stroke programs sometimes have to rely on general radiologists, but neuroradiologists are intimately familiar with strokes. They are specially trained to utilize high-tech imaging and techniques to determine a patient’s status during a stroke emergency as quickly as possible.

“There are special things we can do with CT, MRI and post-processing software” to provide information that can impact the course of treatment the stroke team deems best for the patient, explained Sukhwinder Johnny Singh Sandhu, MD, chief of the division of neuroradiology.

They start with a CT, or computed tomography, scan of the brain to rule out bleeding and to find out where brain cells are dying. Bright white areas indicate bleeding, while black areas show dead cells.

“There may be neighbor cells around dead tissue that are barely hanging on. If you can restore blood flow you may prevent the evolution of a mild stroke into a major one. That could be the difference between grandma living at home independently or grandma dealing with a disability in a nursing home,” Sandhu said.

A magnetic resonance image, or MRI, can also play a role in diagnosing a patient. Less specialized programs don’t always have someone working who can operate the machine and read the results. UF Health’s Comprehensive Stroke Center has staff on hand to operate and read MRIs 24 hours a day, seven days a week.

The team also uses magnetic resonance angiography, or MRA, which allows them to have an up-close look at the brain’s blood vessels without using contrast dye. The images are created using techniques that take advantage of the contrast between flowing blood and stationary brain tissue.

Sandhu said the neuroradiologists are in constant contact with the rest of the stroke team, so they have a strong working relationship. The team relies heavily on the radiologists’ findings when deciding how to proceed with a patient.

“It’s a lot like a great football team. Plays run well when everyone knows what everyone else is supposed to be doing in every type of scenario,” Sandhu explained.

Each case is different and must be carefully examined; a minor change in the shading of one section of the brain or a small, narrowed blood vessel could be the source of the problem. And the best course of action – as well as the technology to find it – is constantly changing.

“Stroke management is an evolving science. The brain is still an unknown frontier,” Sandhu said. “It’s an exciting time. I think, in our lifetime, we’re going to see a lot of advances.”


This article is the fourth in our five-part Striking Out Strokes series. Tomorrow: Care after a stroke is just as important as the initial treatment.


Click on the links below to read the rest of the series:

Striking out strokes with an all-star stroke team

Stroke patient grateful for receiving the “clot buster,” IV-tPA

Treating hemorrhagic strokes a different ballgame than ischemic strokes

Care after a stroke just as critical as the initial treatment