Video 'Selfie' Could Facilitate Diagnosis of Stroke, TIA

Ken Terry

July 08, 2014

A Canadian woman's video "selfie" of a transient ischemic attack (TIA) has prompted stroke experts in this country to speculate about the potential future use of the technology to facilitate stroke treatment.

Widely publicized in news reports and posted on the Internet, the video shows Stacey Yepes, a 49-year-old Toronto-area woman, undergoing a TIA while she describes her symptoms.

Earlier, she'd visited a local emergency department and had been discharged with a diagnosis of stress. When she experienced the same symptoms 2 days later while driving, she pulled her car over and took the selfie to document her symptoms during the attack. The next day, she returned to the hospital. After being transferred to a stroke center, she had an MRI, and a stroke neurologist confirmed she'd had a TIA.

It's not unusual for a TIA or a stroke to be misdiagnosed if the symptoms don't last, noted Bart M. Demaerschalk, MD, director of the teleneurology and telestroke program at the Mayo Clinic in Phoenix, Arizona, in an interview with Medscape Medical News.

"Even in the best of academic stroke centers, approximately 20% to 30% of the patients that present to an ER [emergency room] with a stroke syndrome, including a TIA, ultimately are discharged from that hospital with a diagnosis of something other than stroke," he said.

It's not too likely that somebody experiencing a TIA would have the ability or the presence of mind to take a selfie, he noted. However, the patient might be with someone else who could capture the stroke with a smartphone video or photos, he added.

In either case, a patient with symptoms that she or he believes to be stroke-related or a witness should call 911 first, Dr. Demaerschalk emphasized.

Daniel Lackland, MD, professor of epidemiology and neuroscience at the Medical University of South Carolina, Charleston, concurred. Still, a cell phone video could have "great value" if the patient or an observer took it while awaiting the ambulance, he noted.

"If the person is having an ischemic stroke and we can get tPA [tissue plasminogen activator] to them, the faster we can provide it, the better off they are," Dr. Lackland observed. "So this type of technology could aid the speed at which we can provide a better level of care."

Added Dr. Demaerschalk, "As a stroke neurologist, I'd be very pleased if my patients and their family members who may witness the onset of a stroke syndrome were to walk in and not only tell me what they'd observed but also show me what they'd observed. That would be rich data that would allow stroke neurologists to more accurately diagnose the nature of that event. So I would encourage it."

The next step would be to transmit the video to a stroke center before the patient arrived there. While the technology to do that is widely available, consumers are unlikely to know where the nearest stroke center is or how to contact it in an emergency. There are also concerns about sending personal health information over an insecure connection, said Dr. Demaerschalk.

Dr. Lackland, who is involved in a telestroke program at the Medical University of South Carolina, suggested that someday, people might be able to download apps that would contain all of the requisite information and that would allow them to send a cell phone video securely to the nearest stroke center. Then a stroke specialist, based on what he or she saw in the video, could communicate instructions to the emergency medical services team transporting the patient to the center.

Dr. Demaerschalk said his research team at Mayo is preparing to study a related use of technology that he calls "prehospital telestroke alerts." First, he said, portable videoconferencing units will be placed aboard ground and air ambulances. "When 911 is called, the EMS [emergency medical service] providers activate a prehospital telestroke alert. They begin to broadcast live audio/video conferencing with their assessment of the patient at home or wherever the 911 call took place and all along the route in the ambulance until they arrive at our stroke center.

"Our hypothesis is that if the stroke team doctors have their eyes on the patient earlier, this can facilitate earlier diagnosis and faster treatment time. If we can shave valuable minutes—whether it's 5, 10, or 15 minutes—in advance of the patient's arrival in the ER, we can obtain a faster diagnosis and get on with clot-busting treatment for stroke in a more timely manner."

He can also envision the possibility that the patients themselves might transmit their own video data to a stroke center "simultaneously with the 911 call. That way, the neurologists would have some data they could look at before the patient arrives." The 2 approaches could also be combined, he added.

The Mayo team has published a pair of studies that lend credence to the idea of using telemedicine in emergency stroke treatment. In the first study, a meta-analysis, they showed that the use of stroke telemedicine consultations resulted in correct decisions about thrombolytic eligibility being made in 96% of cases, compared with 83% of cases when symptoms were only reported by phone.

In another study, 2 vascular neurologists were randomly assigned to observe patients with acute stroke syndrome either at the bedside or from a remote location, using the iPhone's video chat feature. In 90% of the cases, the physician present with the patient and the one doing the remote consultation agreed on the diagnosis of stroke and the measure of severity.

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