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> I have a question about this statement. Wouldn't this patient > benefit from a head CT to determine whether or not this is a > hemorrhagic versus non-hemorrhagic stroke? The treatment may > be vastly different. I know in the US we tend to be excessive > in our use of tests and at times overly aggressive in our > treatment strategies. I would like to understand the > difference in this case. > > In the US a patient like this would definitely go to the ED > for a head CT and if the stroke was found to be hemorrhagic > in nature they would then have an angiography to determine > whether the patient had an aneurysm amenable to surgical treatment. There is a fair amount of debate about timing of surgery in these cases. However, most neurosurgeons in the UK will wait for a while (particularly in the elderly patient) as they reckon the risks of early surgery outweigh the benefit. As a result of this, radiologists don't view emergency scans as appropriate. There are a lot of things that can be debated around this- value of emergency c.f. delayed operation; value of emergency CT scan to allow earlier planning of operation; value of later c.f. earlier CT scan; risks and benefits of LP in the absence of CT scan etc.; but the long and short of it is that in most UK hospitals, scans are not available until the next day if they get done at all in these circumstances. Remember that we have a chronic shortage of radiologists and a commitment to keeping waiting lists down, so increased out of hours radiologist availability is a low priority. And I don't know of anywhere in the UK that thrombolyses strokes, although am prepared to be corrected on that. Matt Dunn Warwick This email has been scanned for viruses by NAI AVD however we are unable to accept responsibility for any damage caused by the contents. The opinions expressed in this email represent the views of the sender, not South Warwickshire General Hospitals NHS Trust unless explicitly stated. If you have received this email in error, please notify the sender.