Mystery Solvers: Neuroradiologists Play Critical Role

Each week, the Cedars-Sinai stroke team confers with neuroradiology experts, who are vital to the team’s ability to rapidly assess and treat patients.

The moment a "Code Brain" is sent out at Cedars-Sinai, a team of neurological experts springs into action, racing to evaluate and treat acute stroke in the small window of time that is critical to determining the patient’s path of recovery. Act fast enough, and powerful clot-busting drugs can stop and even reverse damage to the brain.

As stroke team nurses, neurologists and emergency-room physicians work on stabilizing and monitoring the patient’s vital signs, another team springs into action – out of sight, but vital to solving the mystery of the patient’s brain: When did this stroke happen? How did it happen? Why did it happen?

Using advanced diagnostic imaging techniques, the neuroradiology experts at the S. Mark Taper Foundation Imaging Center gather the answers to these questions – answers that are necessary to determine the best course of action.

"This team is on day and night, providing a second set of experienced eyes to the patient’s treatment team – reassuring them they’re doing the right thing and determining if the stroke is treatable," said neuroradiologist James Tourje, MD. "It’s a matter of being right there, ready to stabilize the patient, look at the image and make the best treatment calls. This all happens in 30 minutes."

In that window, neuroradiologists analyze images of the head and neck to determine what kind of stroke a patient has had and how much of the brain is functioning. This information is relayed to the stroke team, and is at the very core of determining what’s next. This team may never step foot in the Emergency Department or even meet the patient, but their expertise is crucial in guiding the life-saving choices made by the rest of the stroke team at the patient’s side.

"Once we have read the images, we can give the stroke team the information they need to treat the patient, or bring them back for additional imaging to identify what else is going on," said neuroradiologist Ravi S. Prasad, MD. "The quicker we can get to saving the brain at risk, the better chance the patient has to getting back to normal function."

Neuroradiologists also are able to recognize when a patient with stroke symptoms is actually experiencing something else entirely, such as a bleeding tumor, or when the patient isn’t a good candidate for tissue plasminogen activator (tPA), an intravenous clot-busting drug. The alternative then is to consider interventional neuroradiology or other surgical interventions.

"We need the expertise of the stroke imaging team to help us make a lot of hard decisions in terms of what therapies to offer," said Shlee Song, MD, associate director of the Stroke Program. "We look at all the images ourselves too, but they are the experts who sign off on it. We cannot do what we do without this branch of the stroke team."

That half hour after a stroke may be the single most important period in the patient’s life. The mystery-solvers in neuroradiology help Cedars-Sinai stroke experts use every second of that time deliberately – working to ensure the best possible outcomes.