วันอังคารที่ 2 ตุลาคม พ.ศ. 2550

Computed tomography (CT)




What is a CT scanner?

A CT (computerised tomography) scanner is a special kind of X-ray machine. Instead of sending out a single X-ray through your body as with ordinary X-rays, several beams are sent simultaneously from different angles.

How does a CT scanner work?

The X-rays from the beams are detected after they have passed through the body and their strength is measured.

Beams that have passed through less dense tissue such as the lungs will be stronger, whereas beams that have passed through denser tissue such as bone will be weaker.

A computer can use this information to work out the relative density of the tissues examined. Each set of measurements made by the scanner is, in effect, a cross-section through the body.

The computer processes the results, displaying them as a two-dimensional picture shown on a monitor. The technique of CT scanning was developed by the British inventor Sir Godfrey Hounsfield, who was awarded the Nobel Prize for his work.

What are CT scans used for?

CT scans are far more detailed than ordinary X-rays. The information from the two-dimensional computer images can be reconstructed to produce three-dimensional images by some modern CT scanners. They can be used to produce virtual images that show what a surgeon would see during an operation.

CT scans have already allowed doctors to inspect the inside of the body without having to operate or perform unpleasant examinations. CT scanning has also proven invaluable in pinpointing tumours and planning treatment with radiotherapy.

What is the CT scanner used for?

The CT scanner was originally designed to take pictures of the brain. Now it is much more advanced and is used for taking pictures of virtually any part of the body.

The scanner is particularly good at testing for bleeding in the brain, for aneurysms (when the wall of an artery swells up), brain tumours and brain damage. It can also find tumours and abscesses throughout the body and is used to assess types of lung disease.

In addition, the CT scanner is used to look at internal injuries such as a torn kidney, spleen or liver; or bony injury, particularly in the spine. CT scanning can also be used to guide biopsies and therapeutic pain procedures.

How is a CT scan prepared for?

If the patient is receiving an abdomen scan, for example, they will be asked not to eat for six hours before the test. They will be given a drink containing gastrografin, an aniseed flavoured X-ray dye, 45 minutes before the procedure. This makes the intestines easier to see on the pictures.

Sometimes a liquid X-ray dye is injected into the veins during the test. This also makes it easier to see the organs, blood vessels or, for example, a tumour. The injection might be a little uncomfortable, and some people also experience a feeling of warmth in their arm.

How is a CT scan carried out?

The scanner looks like a large doughnut. During the scan the patient lies on a bed, with the body part under examination placed in the round tunnel or opening of the scanner. The bed then moves slowly backwards and forwards to allow the scanner to take pictures of the body, although it does not touch the patient. The length of the test depends on the number of pictures and the different angles taken.

How is a CT scan carried out?

The examination does not hurt but some people find it uncomfortable to lie in the tunnel. As there is little room inside the tunnel, people who suffer from severe claustrophobia sometimes have problems with CT scans.

Let the doctors and radiographers know if this might be a problem. Other people get slightly nervous because of the whirring noise the machine makes while working.

Is a CT scan dangerous?

Far more X-rays are involved in a CT scan than in ordinary X-rays, so doctors do not recommend CT scans without a good medical reason. Some patients may experience side effects due to allergic reactions to the liquid dye injected into the veins.

In very rare cases, this dye has been known to damage already weakened kidneys. It is important to let the X-ray doctors or technicians know if you have any allergies, asthma or kidney trouble , prior to having the X-ray dye injected.

How is a CT scan read?

A CT scan can give the doctor a much clearer picture of the inside of the body than an ordinary X-ray. For example, different types of tissue such as bone, muscle and fatty tissue are easy to see on a CT scan. When looking at the abdomen, the scan shows various organs such as the pancreas, spleen and liver.

When it is necessary to look at the brain, the areas containing liquid - the ventricles - are also clearly defined. Very small shadows on the lungs can also be detected using CT and there are now studies looking into using it as a screening test for lung cancer.

วันพุธที่ 26 กันยายน พ.ศ. 2550

How to Avoid Another Stroke

Secondary prevention to reduce your risk

Secondary prevention is a very serious matter

40% of stroke survivors have a second stroke within five years with the highest risk being in the first few months after the stroke or TIA.

A repeat stroke is frequently more devastating than the first.

Lifestyle adjustments often need to be made- these seem simple but require commitment and permanence.

Secondary prevention measures include:
  • Regular checks by your doctor for:
    Blood pressure
    Cholesterol
    High blood pressure and high cholesterol usually respond well to medication taken as prescribed
    Diabetes
    Control diabetes by following medical advice carefully
    Heart beat
  • Don’t smokeStopping smoking is not easy for the dedicated smoker – but it is vital - it is possible to give up cigarettes. Assistance is available.
  • Reduce your stress levels
  • Limit your alcohol intake
  • Manage your weight
  • Exercise regularlyMany forms of exercise are available to suit individual tastes. Walking is easy –no special equipment, can be done at any time, in most weather –exercise that also provides fun, pleasure and companionship is very valuable.
  • Eat a balanced diet, avoid food high in salt and fat
  • Enjoy work and play
  • Follow medical advice faithfully

Life After Stroke

Patients are generally encouraged to return to their normal lives - depending on the effects persisting from stroke

Some aspects of life after stroke include:

  • Resuming work How soon this is possible depends partly on remaining disability, the type of work involved, and the feelings about returning to work. Some people feel quite tired after a stroke, and have difficulty carrying out any kind of physical activity for any length of time. Part-time work at least in the early stages may be a good idea. Unless the stroke has reduced awareness of impairment, it is probable that the person who had the stroke is the best judge of when to return to work.
  • Driving Even someone who appears to have made a full recovery after stroke should not drive a car for at least a month as the risk of another stroke is greatest at this time. To drive again involves being cleared by the doctor (who will be aware of relevant government regulations) as the stroke may have left subtle impairments, not always apparent, such as poor co-ordination, lack of awareness on one side, difficulties in judging distance, changes in vision, difficulties in concentration and confusion between left and right.
  • Sexual activity Resumption of sexual activity after stroke is encouraged. Most couples experience some difficulty in their sex life after stroke, but this is usually due to psychological factors rather than any disability caused by stroke. A doctor can advise on any difficulty such as erectile problems in men.
  • Sport and Exercise Resumption of physical activity and hobbies is an important part of rehabilitation- normal activity should be resumed as soon as physically possible.
  • Drinking Alcohol The intake of excessive amounts of alcohol should be avoided after stroke as it may interact adversely with medication, raise blood pressure, and affect judgement resulting in injury. Moderate consumption (two standard drinks per day) should not cause any problem.

Reviewed by Professor Alastair Corbett, Consultant Neurologist, Concord Hospital
Date created: 26 September 2003

Treatment of Stroke

Regular medical supervision, medication and lifestyle changes

Medical advice will be given on continuing care for stroke survivors and may include:
  • Regular medical supervision
    Regular checks of blood pressure, and cholesterol levels leading to appropriate medication
    Carotid surgery -one in ten stroke patients have a very narrow artery in the front of the neck on one side (the carotid artery) that restricts the flow of blood to the brain. Surgery to open and clear the artery or to place a small cylinder (stent) in it will increase the flow.
  • Medication – two kinds of tablets are prescribed: “clot-busters” and blood-thinners
    Anti-clotting (antiplatelet) medication, such as aspirin, probably in combination with another drug such as clopidogrel or dipyridamole (for those patients who have had an ischaemic stroke caused by a clot forming on an area of hardening of the arteries).
    Anti-coagulant medication (such as warfarin) where an ischaemic stroke has been caused by a blood clot forming in the heart, breaking off and lodging in the brain. These drugs are very powerful, may have significant side effects and must be carefully supervised by the doctor.
  • Changes to lifestyle
    Attention to diet, which should be varied, but low in saturated fat, alcohol, and salt, and high in fibre, fruit and vegetables.
    Avoidance of smoking - this is absolutely essential.
    Stress management - stress in life is unavoidable but can be reduced by various strategies including exercise, changing attitudes to work, meditation and relaxation.
    Regular exercise – which will help to regulate weight and improve circulation.

Reviewed by Professor Alastair Corbett, Consultant Neurologist, Concord Hospital
Date created: 26 September 2003

Effects of Stroke

The most common problems in daily life are likely to be caused by:
  • Weakness or lack of movement (paralysis) in legs and/or arms
  • Shoulder pain
  • Trouble swallowing
  • Changes to way things are seen or felt (perceptual problems)
  • Changes to the way things are felt when touched (sensory problems)
  • Problems thinking or remembering (cognitive problems)
  • Trouble speaking, reading or writing
  • Incontinence
  • Feeling depressed
  • Problems controlling feelings
  • Tiredness

The specific abilities that will be lost or affected by stroke depend on the extent of the brain damage and, most importantly, where, in the brain, the stroke occurred: the right hemisphere (or half), the left hemisphere, the cerebellum or the brain stem.

Effects of Right Hemisphere Strokes

The right hemisphere of the brain controls the movement of the left side of the body so stroke in the right hemisphere often causes paralysis in the left side of the body. This is known as left hemiplegia.

Survivors of right-hemisphere strokes may also have problems with their spatial and perceptual abilities. This may cause them to misjudge distances (leading to a fall) or be unable to guide their hands to pick up an object, button a shirt or tie their shoes. They may even be unable to tell right side up from upside-down when trying to read.

Along with these physical effects, survivors of right-hemisphere strokes often have judgment difficulties that show up in their behaviour. They often act impulsively, unaware of their impairments and certain of their ability to perform the same tasks as before the stroke. This can be extremely dangerous. It may lead them to try to walk without aid or to try to drive a car.

Survivors of right-hemisphere strokes may also experience left-sided neglect. This is a result of visual difficulties that cause them to "forget" or "ignore" objects or people on their left side.

Some survivors of right-hemisphere strokes will experience problems with short-term memory. Although they may be able to recall a visit to the seashore that took place 30 years ago, they may be unable to remember what they ate for breakfast that morning.

Effects of Left Hemisphere Strokes

The left hemisphere of the brain controls the movement of the right side of the body. It also controls speech and language abilities for most people. A left-hemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia.

Someone who has had a left-hemisphere stroke may also develop aphasia. Aphasia is a catch all term used to describe a wide range of speech and language problems. These problems can be highly specific, affecting only one part of the patient's ability to communicate, such as the ability to move their speech-related muscles to talk properly. The same patient may be completely unimpaired when it comes to writing, reading or understanding speech.

In contrast to survivors of right-hemisphere stroke, patients who have had a left-hemisphere stroke often develop a slow and cautious behaviour. They may need frequent instruction and feedback to finish tasks.

Patients with left-hemisphere stroke may develop memory problems similar to those of right-hemisphere stroke survivors. These problems can include shortened retention spans, difficulty in learning new information and problems in conceptualising and generalising.

Effects of Cerebellum Strokes

The cerebellum controls many of our reflexes and much of our balance and coordination. A stroke that takes place in the cerebellum can cause abnormal reflexes of the head and torso, coordination and balance problems, dizziness, nausea and vomiting.

Effects of Brain Stem Strokes

Strokes that occur in the brain stem are especially devastating. The brain stem is the area of the brain that controls all of our involuntary functions, such as breathing rate, blood pressure and heart beat. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing. Since impulses generated in the brain's hemispheres must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis in one or both sides of the body.

Other Effects of Stroke

Depression is very common amongst people who have had a stroke. It can be quite severe, affecting both the survivor and his/her family. A depressed person may refuse or neglect to take medications, may not be motivated to take part in physical rehabilitation or may be irritable with others. This in turn makes it difficult for those who wish to help, and tends to deprive the survivor of valuable social contacts that could help dispel the depression. In time the depression may lift gradually, but counselling and appropriate medication may be necessary. In the past, researchers speculated that some of the older anti-depressant drugs might interfere with a person's mental performance but recent studies suggest that anything that can effectively treat post-stroke depression, whether an old or new treatment, may also improve mental ability and enhance rehabilitation.

Sudden laughing or crying for no apparent reason and difficulty controlling emotional responses also affects many stroke survivors. There may be little happiness or sadness involved, and theexcessive emotional display will end as quickly as it started.

Apparent changes in personality following a stroke may be very disturbing to the survivor’s family. Stroke affected people may not seem the same person as before. The way in which they think, feel and react may be altered. Problems and activities once tackled easily may be difficult or impossible, while other tasks are unaffected.

The way in which the person affected by stroke reacts to these changes will affect their personality, and may cause changes in control of emotions and behaviour. People affected by stroke may become confused, self-centred, uncooperative and irritable, and may have rapid changes in mood. They may not be able to adjust easily to anything new and may become anxious, annoyed or tearful over seemingly small matters.

Reviewed by Professor Alastair Corbett, Consultant Neurologist, Concord Hospital

Date created: 26 September 2003