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Medicine

'Selfie' Helps Doctors Diagnose Mini-Stroke 47

Posted by timothy
from the socially-redeeming-value dept.
OakDragon (885217) writes A Toronto woman had the presence of mind to record herself, using her smartphone, as she suffered from a bout of semi-paralysis. She had suffered the same symptoms two days earlier, and had gone to the hospital; but by that time the condition had passed, and doctors sent her home. However, using the smartphone video, doctors later diagnosed her with a transient ischemic attack, or mini-stroke. The diagnosis was confirmed with an MRI.
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'Selfie' Helps Doctors Diagnose Mini-Stroke

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  • by Anonymous Coward on Thursday June 19, 2014 @09:20AM (#47271821)

    This is among the consequences of a surveillance society.

    That's only the case if it is the subjects of the surveillance - we, the people - who have control over the retention and dissemination of the information.

  • by fredrated (639554) on Thursday June 19, 2014 @10:24AM (#47272651) Journal

    Taking a picture of yourself is one of the consequences of a surveillance society? Afraid I don't follow you.

  • by DNS-and-BIND (461968) on Thursday June 19, 2014 @10:50AM (#47272967) Homepage
    How's this a "woman thing" again? The medical profession is snappy and high-handed with both sexes. They don't care about you any more than a mechanic cares about a car. But I guess to certain people everything is a male oppression dystopia because that's all they think about all day long. It is a poor witch-hunter who cannot find witches.
  • by Dcnjoe60 (682885) on Thursday June 19, 2014 @10:54AM (#47273019)

    There is something wrong with this story. Doctor's won't discount a TIA because the symptoms subsided. That is exactly why they are transient! The news this morning also ran this story and indicated that the doctors had originally concluded it was stressed induced (conversion reaction). The problem is if it was a conversion reaction, then the video would not disprove that. Furthermore, after seeing the video, they did an MRI and found an indication. Why was that not done originally? Standard response for a TIA is to do an MRI. Besides, if damage was now detected, it indicates she did not have a TIA but had a stroke.

    Something is not quite right with this story.

  • Very smart (Score:0, Insightful)

    by Anonymous Coward on Thursday June 19, 2014 @12:36PM (#47274127)

    I say this with respect to your comment. But how is it the women didn't receive a MRI the first damn time she went to the hospital? The doctors had to "witness or watch the video" then decided it was a good idea to give the women an MRI?

    It isn't cheap (for laughable reasons) for an MRI, but we should be seeing cheap and accurate scanning tech by now! It great to know you have health insurance, but you better pray the doctors are going to catch whatever is wrong with you before they rack up thousands of dollars in tests, or they just blow it off as someone overreacting to something minor or non-life threatening.

    Doctors are like public defenders they simply don't give a shit, on to the next sucker. Not all doctors are like that, few still actually care and remember the reasons for why they do what they do. And I really blame how defunct our medical industry is that things are ran like your placing an order at a fast food drive-thru.

  • by Stickerboy (61554) on Thursday June 19, 2014 @03:14PM (#47275685) Homepage

    I'd like to know why the doctors didn't ask for an MRI the first time around. Why did the patient need to wait and get "proof" there was a real problem? Intact why don't we get an full body MRI and maybe even a CT scan maybe every 20 years to find possible problems before they happen?

    Well, IAAD. I don't have access to the notes/file, but I can give a pretty reasonable guess to your answers.

    Why didn't the doctor ask for an MRI the first time around? Well, she went to the ER. Now, admittedly, I haven't worked in the Canadian system or outside of 2 confluent states here in the US, but standard of practice where I have worked is that ER doctors do not have access to MRI scans. They take way too long for the fast turnaround of ER care. MRIs can take 30 minutes to multiples of hours. CT scans take a few minutes. MRIs are either handled by outpatient scheduling or by admitting the patient for an inpatient stay in the hospital. On top of that, any stroke suspicion automatically gets a CT of the head without contrast to rule out intracranial bleeding, which is by far the most serious and emergent diagnosis from that class of symptoms. Tangentially, a CT of the head likely would not have picked up a small ischemic stroke like her later MRI.

    Why did the patient need to wait and get proof? Well, with the story written down and no workplace rush, hindsight says she probably deserved an inpatient workup for a TIA the first time around. The #1 cause of misdiagnosis is failure of doctor-patient communication. With a completely normal physical/neurological exam, all it takes is for a slightly confusing or badly told patient story (which NEVER happens, of course, with a patient freaked out about a possible medical problem) or a doctor that's not hearing or associating the right phrases to lead them down the TIA/stroke diagnosis pathway to be sent home.

    Now let's turn this around, based on her initial episode on presentation to the ER. You're the patient that just had a five minute spell of weirdness that includes, "had trouble speaking words". In a few minutes, those symptoms were gone like it never happened. A CT scan will likely be negative for anything (but it will dose you with about 20 chest X-rays' worth of radiation to your brain). By definition, a TIA won't show anything on MRI (a small-scale infarct on MRI is a stroke, period). There is no medical "fix", as TIAs are self-limiting and resolve themselves - there is only secondary prevention. If this is a TIA, your best treatment includes going on aspirin daily (ulcer risk), antiplatelet medication like Plavix daily (bleeding risk), and a statin daily (multiple adverse effects well-documented. You can avoid taking if LDL is already low). On the basis of five minutes of symptoms that haven't returned, would you feel like taking this medication for the rest of your life? Does dosing every single person that comes in with a similar story with a combination of multiple medications sound like a good outcome?

    Third, why doesn't everyone get a full body MRI and maybe even a CT scan every 20 years? Well, you can. You'll need a credit/debit card or an appropriately-sized stack of cash, but radiology suites will be glad to scan you. I'd hate to put words in their mouths, but I would venture to say that would be their preferred business model. Especially if they could get away with not having to deal with third-party payers.

    Oh! You want someone else to pay for your scan. First, you need a good reason to order the scan to get someone else to pay for it. So let's think about it. Multiply thousands of dollars of unnecessary scans times 300 million people+ here in the US, rotating every 20 years. Then factor in all the incidental findings which will be inconclusive and need either further scans or maybe invasive surgical procedures to investigate. Factor in complications and harms from procedures and radiation dosing (a single CT of the chest is equivalent to about 70 chest X-rays, which is not insignificant in term

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