Do CT scans always show a brain hemmorhage initially....

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    ....or can it sometimes take a few hours after a patient's symptoms have started (mental status change/extremity weakness, etc.) to show up? I always thought you would see bleeding right away on a head CT, but a peer of mine says not necessarily. She states that is why neuro patients are usually rescanned within 24 hours. I decided to turn towards the experts (the neuro nurses) for the answer! Textbooks I have consulted have not given me a definitive answer.

    Any insight would be greatly appreciated!
    Last edit by Spacklehead on Jan 26, '07
  2. 4 Comments so far...

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    Quote from Softballmama
    ....or can it sometimes take a few hours after a patient's symptoms have started (mental status change/extremity weakness, etc.) to show up? I always thought you would see bleeding right away on a head CT, but a peer of mine says not necessarily. She states that is why neuro patients are usually rescanned within 24 hours. I decided to turn towards the experts (the neuro nurses) for the answer! Textbooks I have consulted have not given me a definitive answer.

    Any insight would be greatly appreciated!
    If the bleeding is significant...yes, you'll see it. The only reason you wouldnt see it is if it were VERY tiny.
    If your patient is symptomatic from a bleed, it WONT be insignificant and you WILL see it on initial scan.
    If a bleed is so minor/tiny that you dont pick it up on initial scan, the bleeding is likely NOT the primary cause of symptoms. (ie head trauma/contusion that initially wont show blood...but causing symptoms...may show bleeding on subsequent scans...)

    Certain ischemic strokes (especially embolic!) will convert into a bleeding cva, so it's wise to do follow-ups...especially because these patients are generally on heparin/thinners of some sort...

    it's the ischemic strokes that in general wont show up for 24-48 post event...
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    Chronic Sub-durals that have been sitting there for about 3 weeks can be difficult to see on CT because they become Isodense. But fresh haemorrhage usually shows up.
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    Generally CT scans show a bleed and of course this is without contrast. If it were with contrast, you wouldn't know if it was a bleed vs contrast.

    Plain CT's do not always show an Ischemic stroke. This is what happened to my Mom back in Oct. On the 5th day, I told my Mom's Neurologist that Mom is nuts. She isn't Mom. I had to fight for a MRI. Want to learn something? Her so-called TIA which I said wasn't so turned out to be an Ischemic Stroke just like I had said. How about in 3 places!!!! Left Temporal-Parietal-Occipital areas. Thank goodness I have an extensive Neuro ICU background or else I wouldn't have had a clue what I was talking about. The Neuro Dr. apologized profusely because he was totally wrong. Too bad Mom wasn't TPA'd. We could have made the Stroke a lot less an impact.
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    Unless the bleed is a very tiny bleed, all modern CT scanners should show it. Now with ischemic stroke, the area that has stroked will have changes in density, and these are seen as early as 3 hours after the event has occured. This is part of the reason, the administration of TPA and other clot busters is dependent upon the CT reading. If the CT shows a hypodense area already, you are likely putting the patient at more risk than potential benefit by using that "clot-buster."

    The re-scan is often times done to assess the degree of involvement, or due to continuing or worsening symptoms. More or less, the repeat scan is often times a prognostic indicator.


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