A patient presented to the medicine casualty with left hemiparesisof 5 hours duration. His NCCT head was sought correctly and immediately, the images are underneath, what do they show??

Well the casualty resident took his time and came to the conclusion that this was normal, and surprisingly informed the clinical neurology resident instead of the interventional guys. By the time the interventionist 'intervened' it was 8 hours and an MRI also had got done, which 'showed' that there were acute infarcts on right side (see ADC images below)

So where was the problem????

1. the patient lost an opportunity to have a possible treatment----endovascular thrombolysis; he had come in the window period for the same!!!

2. Our emergencies are just not geared up for neurological emergencies...stroke...

3. Residents are not exposed to nor adequately trained in emergency radiology

4. radiology residents are not available most of the time when needed most....I am saying this even though I tack...I am one

5.people are unaware of stroke and its treatment...unlike myocardial infarction ...heart attack...which even villagers know about

6. Clinical neurologists are not keen to go beyond intravenous thrombolysis, neither are they keen to improve mass awareness----probably they will have to do lot of emergency night work....ha ha....

7. etc etc etc etc...

have a look at the marked region in the original CT...clear evidence of acute infarct...missed entirely by casualty and clinical neurology resident!!!!

What they did however was get a CT after 3 days which showed the expected results...

What treatment can we offer now!!!

PHYSIOTHERAPY..

AND...a lot of investigations.....Homocystiene, B12, Lipids, MRI, MRA, Doppler...so on, so forth