Retired minister Will Hille of Spokane recently learned first hand the amazing outcomes a stroke patient can have when brain imaging is readily available as part of a primary stroke center.

Rev. Hille, 71, was having breakfast at an area restaurant when staff and a friend began to notice a droop on the right side of Hille’s face, as well as his apparent difficulty in speaking. In addition, Hille complained of weakness in his right arm and leg. He was rushed to Sacred Heart Medical Center’s (SHMC) emergency department where he was evaluated by emergency physician Dave McClellan, MD, who then activated the stroke system.

   It takes a number of professionals to carry out stroke care in an efficient and effective manner. At Sacred Heart, the stroke team includes an emergency physician and nurses, a neurologist, a stroke coordinator, a pharmacist and a research coordinator. In addition, it includes individuals dedicated to brain imaging including a CT technologist and neuroradiologist.

   “Because time is of the essence in treating acute stroke cases, ER physicians order imaging studies immediately to get a diagnosis,” explains William Keyes, MD, an Inland Imaging neuroradiologist involved with the case.“ In Rev. Hille’s case, the perfusion CT showed an obvious problem that was not readily apparent on the plain CT. Then, a CT angiogram confirmed suspicions on the plain CT. Rev. Hille clearly was in the midst of an acute stroke.”

Rev. Hille's plain CT did not readily show the problem.	Blue areas represent areas of injury due to the stroke.

   Modern imaging studies provide information about the possible degree of reversibility of stroke injury and the status of blood vessels in the brain. More importantly, brain imaging findings, including the size, location, and distribution of the stroke as well as the presence of bleeding, affect both acute and long-term treatment decisions.

   In Rev. Hille’s acute case, neuroimaging tests were used to identify his eligibility for treatment by thrombolytic agents, specifically tPA.

   “With the advent of tPA treatment, interest has grown in using CT to identify subtle, early signs of ischemic brain injury or arterial occlusion that might affect decisions about treatment,” says Keyes. “Rev. Hille’s brain imaging study identified regions of salvageable brain tissue and recognized occlusions of large arteries that were amenable to therapy.”

   The national standard for completing the initial tests and actually infusing tPA is 60 minutes; Rev. Hille received his dose within 50 minutes.

   “Within 10 minutes, we began to see improvement,” says Sherry Nash, stroke coordinator at SHMC. “Will was gaining control in his right arm again, the facial droop was improving and his speech became clearer.”

   Once those milestones were reached, he was transferred to the Neuro Intensive Care Unit for overnight observation. After just two days, he had no stroke symptoms remaining.

   “Close collaboration among neurologists, emergency physicians and radiologists is essential in acquiring the brain imaging that is required to guide acute intervention,” notes Dr. Keyes.

   Rev. Hille and his wife Sue certainly agree.

   “They moved fast,” says Hille. “It was impressive.”

   Home after just two nights in the hospital, Rev. Hille touts the modern miracle of brain imaging and its correlation to his life altering treatment, “I’d be living in a nursing home and not be talking to you now if it were not for the tPA and how quickly I got it.”