Aims and objectives
To study the different imaging findings in relatively young patients who presented clinically with symptoms suggesting ischaemic stroke but on imaging,
their findings were an aberration from the normal.
Here we have a variety of patients from all age strata who on presentation to the emergency department had clinical presentation suggestive of different circulation territorial stroke but on imaging had differing appearances.
Methods and materials
Timely diagnosis and management of stroke in young is important as it constitutes to be an important cause for mortality and morbidity in recent times.
Hence,
basic CT and MRI screening form a routine protocol.
MRI screening which includes DW,
ADC,
FLAIR and SWI sequences.
On the basis of the results of this study,
further neuroimaging protocol to include complete MRI brain study with intracranial and cervical MR angiography and if required,
post-contrast administration imaging is also done.
Also,
if clinical and initial neuroimaging features...
Results
In every clinical suspicion of stroke in young,
neuroimaging forms a cornerstone.
Here we have a series of atypical presentations found on imaging in below mentioned differing case scenarios.
CASE I. A 27-year-old female patient presented to the casualty with sudden onset and progressive right-sided hemiplegia,
ataxia,
and slurring of speech.
Initial MRI screening revealed restricted diffusion mainly in left occipital and high fronto-parietal lobes.
MR brain angiogram revealedmarked narrowing of cavernous portion of left ICA with opening of multipleprominent lenticulostriate collaterals.
Fig. 1
Diagnosis:...
Conclusion
Early diagnosis is essential for any young patient coming with stroke-like symptoms with neuroimaging playing a key role.
Moyamoya disease/ phenomenon,
CADASIL/ CARASIL,
Cervicointracranial artery dissection and vasculitis could be the causes of these atypical strokes with management plan varying as per etiology.
Hence these possible etiologies should be kept in mind by a neuroradiologist for any young stroke coming for imaging.
Personal information
Dr.
Ankita Dhawan,
Consultant Radiologist,
Zydus Hospital,
Ahmedabad 380054.
Email id:
[email protected].
Dr.
Gaurav Goswami,
Consultant Radiologist,
Zydus Hospital,
Ahmedabad 380054.
Email id:
[email protected]
Dr.
Ramesh Mangal,
Consultant Radiologist,
Zydus Hospital,
Ahmedabad 380054.
Email id:
[email protected]
References
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Stojanov D,
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Aracki-Trenkic A,
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KANOTO M,
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Diagnosis of Intracranial Artery Dissection.
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