Learning objectives
To identify early CT and MR brain imaging findings of acute ischemic stroke and contraindications for thrombolysis in anterior circulation.
To describe the usefulness of the different imaging modalities for the diagnosis and treatment of patients during an acute ischemic stroke.
To review the attention times and patient flow in the imaging department during an acute ischemic stroke.
Background
ABBREVIATIONS
AHA: American Heart Association.
ASA: American Stroke Association.
ASPECTS: Alberta Stroke Programme Early CT Score.
CNS: Central Nervous System.
CT: Computed tomography.
CVA: Cerebrovascular accident.
ICA: Internal Carotid Artery.
MCA: Middle Cerebral Artery.
MR: Magnetic Resonance.
mRs: Modified Rankin Score.
NIHSS: National Institute of Health Stroke Scale.
rt-PA: Recombinant tissue Plasminogen Activator.
TBI: Traumatic Brain Injury.
The autors deny any conflict of interest related directly or indirectly to the constitution and research process in the cerebrovascular disease center of the Fundacion Santa Fe de...
Findings and procedure details
DIAGNOSIS
In the next image,
you will find the advantages and diasadvantages of the different imaging modalities in acute ischemic stroke.
Fig 1
EARLY FINDINGS OF ACUTE ISCHEMIC STROKE
COMPUTED TOMOGRAPHY
CT Head without contrast (w/o C)
It allows to classify the CVA in hemorrhagic or ischemic.
EARLY SIGNS OF ISCHEMIA CVA IN CT HEAD WITHOUT CONTRAST ARE:
Loss of gray-white matter differentiation.
Hyperdense artery (Hyperdense MCA and "Dot" sign) [4,5,8].
Fig 2-4
Important tips
The sign is often present after 90 minutes
30% sensibility...
Conclusion
Imaging plays a fundamental and determinant role in the care of patient with acute ischemic stroke,
for the diagnosis,
treatment and follow up.
CT and MR are useful,
which one to be used should be determined according to local factors.
Each modality of image has advantages and disadvantages that should be taken into account,
to choose the image modality for each patient,
according to the time of symptoms onset.
Posterior circulation stroke are evaluated differently.
The knowledge of the evaluation scales,
imaging findings and times...
References
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Sacco R,
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et al.
An updated definition of Stroke for the 21st century; Stroke.
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Portegies M,
Koudstaal P,
Ikram M.
Cerebrovascular disease.
Handb Clin Neurol.
2016; 138:239-61.
3.
Astrup J,
Siesjo B,
Symon L.
Thresholds in cerebral ischemia- the ischemic penumbra.
Stroke.
1981; 12:723-725
4.
Abul-kasim K,
Brizzi M,
Petersson J.
Hyperdense middle cerebral artery sign is an omnious prognostic marker despite optimal workflow.
Acta neurol Scand.
2010; 122(2): 132-9.
5.
Barber P,
Demchuk A,
Hudon M,
Pexman...