Stroke imaging
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Classification of stroke, clinical stages of stroke, types of imaging used for diagnosis with explanations on the findings. Brief overview of ICP (increased intracranial pressure), causes, symptoms and management.
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Imaging in acute stroke
This document provides an overview of imaging in acute stroke. It discusses the goals of imaging evaluation for acute stroke which are to establish a diagnosis, guide treatment, assess location and size of involved territory, rule out hemorrhage and mimics, and obtain information about vasculature and perfusion. CT is the first-line test and can detect early signs of stroke within 6 hours. MRI, including DWI, is very sensitive for acute ischemia. CT angiography and perfusion can assess vessels, blood flow, and the ischemic penumbra. Different territories are discussed along with imaging findings and the physical basis of signs seen on various sequences.
Imaging in acute stroke
This document discusses imaging for stroke. It begins by introducing the types and pathophysiology of stroke, including ischemic and hemorrhagic strokes. It then covers the anatomy of arterial circulation and goals of imaging in acute stroke. Key imaging modalities are computed tomography (CT) and magnetic resonance imaging (MRI). CT is useful for quickly ruling out hemorrhage. Early signs of infarction on CT include hypoattenuating brain tissue and obscuration of the lentiform nucleus. MRI is more sensitive for detecting acute infarction and can identify the ischemic penumbra. Imaging aims to assess the brain parenchyma, vessels, perfusion, and potentially salvageable penumbra tissue.
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Imaging in stroke
This document discusses stroke, including its types, causes, pathophysiology, imaging findings, and clinical features. It provides the following key points:
1. Stroke is caused by ischemia or hemorrhage in the brain. The main types are cerebral infarction (80%), intracerebral hemorrhage (15%), and subarachnoid hemorrhage (5%).
2. Imaging plays an important role in assessing the parenchyma, vessels, perfusion, and penumbra to guide therapy and predict outcomes. Techniques include CT, MRI, CT/MR perfusion, and angiography.
3. CT findings evolve over time from hyperacute to chronic stages. Early signs include
Imaging in acute stroke
This document discusses the use of various imaging modalities such as CT, MRI, CTA, and CTP in evaluating patients presenting with acute stroke. It outlines the goals of acute stroke imaging as establishing the diagnosis, obtaining information on vasculature, and guiding appropriate therapy. CT is described as the initial test to rule out hemorrhage and identify early signs of infarction. MRI sequences such as DWI, T2WI, and FLAIR are also summarized. The roles of CTA in evaluating vessels and CTP in identifying tissue at risk of infarction are covered. Imaging findings of ischemic and hemorrhagic stroke subtypes are presented.
Imaging in stroke
This document discusses various imaging modalities for stroke, focusing on their ability to assess the 4 P's: parenchyma, pipes, perfusion, and penumbra. CT techniques like non-contrast CT, CTA, and CTP can quickly detect hemorrhage, visualize vessels for clots, and assess perfusion/penumbra. MRI techniques like DWI, PWI, MRA provide highly sensitive visualization of acute ischemia and perfusion abnormalities to identify the ischemic core and penumbra. Imaging plays a crucial role in the early diagnosis and management of stroke by establishing the diagnosis, guiding therapy decisions, and identifying salvageable brain tissue.
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Imaging in acute stroke
This document discusses imaging for stroke. It begins by introducing the types and pathophysiology of stroke, including ischemic and hemorrhagic strokes. It then covers the anatomy of arterial circulation and goals of imaging in acute stroke. Key imaging modalities are computed tomography (CT) and magnetic resonance imaging (MRI). CT is useful for quickly ruling out hemorrhage. Early signs of infarction on CT include hypoattenuating brain tissue and obscuration of the lentiform nucleus. MRI is more sensitive for detecting acute infarction and can identify the ischemic penumbra. Imaging aims to assess the brain parenchyma, vessels, perfusion, and potentially salvageable penumbra tissue.
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Imaging in stroke
This document discusses stroke, including its types, causes, pathophysiology, imaging findings, and clinical features. It provides the following key points:
1. Stroke is caused by ischemia or hemorrhage in the brain. The main types are cerebral infarction (80%), intracerebral hemorrhage (15%), and subarachnoid hemorrhage (5%).
2. Imaging plays an important role in assessing the parenchyma, vessels, perfusion, and penumbra to guide therapy and predict outcomes. Techniques include CT, MRI, CT/MR perfusion, and angiography.
3. CT findings evolve over time from hyperacute to chronic stages. Early signs include
Imaging in acute stroke
This document discusses the use of various imaging modalities such as CT, MRI, CTA, and CTP in evaluating patients presenting with acute stroke. It outlines the goals of acute stroke imaging as establishing the diagnosis, obtaining information on vasculature, and guiding appropriate therapy. CT is described as the initial test to rule out hemorrhage and identify early signs of infarction. MRI sequences such as DWI, T2WI, and FLAIR are also summarized. The roles of CTA in evaluating vessels and CTP in identifying tissue at risk of infarction are covered. Imaging findings of ischemic and hemorrhagic stroke subtypes are presented.
Imaging in stroke
This document discusses various imaging modalities for stroke, focusing on their ability to assess the 4 P's: parenchyma, pipes, perfusion, and penumbra. CT techniques like non-contrast CT, CTA, and CTP can quickly detect hemorrhage, visualize vessels for clots, and assess perfusion/penumbra. MRI techniques like DWI, PWI, MRA provide highly sensitive visualization of acute ischemia and perfusion abnormalities to identify the ischemic core and penumbra. Imaging plays a crucial role in the early diagnosis and management of stroke by establishing the diagnosis, guiding therapy decisions, and identifying salvageable brain tissue.
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2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
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3) MRI is more sensitive than CT for acute stroke, detecting most infarcts by 24 hours. Diffusion-weighted imaging (DWI) is most sensitive in the first few hours. Perfusion imaging assesses penumbra.
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This document summarizes radiological imaging techniques for diagnosing and characterizing cerebral ischemia (lack of blood flow to the brain). CT and MRI are useful for detecting early signs of ischemia and identifying the location and size of infarcts (areas of dead brain tissue). CT perfusion and angiography can further identify regions of critically low blood flow termed the "ischemic penumbra" that may be salvaged by rapid reperfusion. Different sequences on MRI such as DWI, T2, and T1 weighted imaging can detect ischemia at various time points and characterize the progression of injury over time. Together, these advanced imaging modalities aid in diagnosis, prognosis, and guiding of acute stroke treatment.
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stroke FOAM Acute central nervous system injury with abrupt onset
Acute central nervous system injury with abrupt
onset
Mechanism:
• Interruption of blood flow(Ischemic Stroke)
or
• Bleeding into or around the brain(Hemorrhagic
stroke)
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2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
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The document provides an overview of cerebral arterial and venous anatomy. It discusses:
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2) The branches of major arteries like the external carotid, vertebral, and basilar arteries.
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Similar to Stroke imaging
stroke FOAM Acute central nervous system injury with abrupt onset
Acute central nervous system injury with abrupt
onset
Mechanism:
• Interruption of blood flow(Ischemic Stroke)
or
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stroke)
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This document discusses imaging techniques for diagnosing strokes. It notes that CT scans are the initial test but can miss acute infarcts in up to 40% of cases within 24 hours. Diffusion-weighted MRI can detect strokes within 30 minutes and is more sensitive than CT for early detection. Perfusion imaging provides information on tissue at risk. The document reviews signs of acute infarction on CT and MRI appearances of different stroke types and hemorrhages. It emphasizes the importance of rapidly diagnosing strokes to determine treatment.
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This document discusses imaging techniques for diagnosing strokes. It notes that CT scans are the initial test but only detect about 40% of strokes within 24 hours. MRI diffusion weighted imaging can detect strokes even earlier, within 30 minutes. Perfusion imaging can further identify tissue that is at risk. The document reviews signs of acute ischemia on CT like obscuration of the lentiform nucleus. It also discusses differentiating strokes from tumors, hemorrhages and other conditions. Advanced MRI techniques like perfusion imaging help identify potentially salvageable brain tissue. Overall imaging plays a crucial role in the diagnosis and management of acute stroke.
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1. The document discusses the diagnosis and management of stroke. It defines stroke, reviews the etiology and types of stroke, and describes tools to assess stroke severity such as the NIHSS score.
2. Acute management of stroke is discussed for both ischemic and hemorrhagic stroke. Treatment options for ischemic stroke include tPA administration and mechanical thrombectomy. Surgery may be considered for hemorrhagic stroke depending on location and size of bleeding.
3. Supportive care measures are also outlined, such as blood pressure and glucose management, antiepileptic drugs, and treating fever, to improve stroke outcomes. The document emphasizes the importance of specialized stroke units for patient care.
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The document outlines the importance of early management of stroke in the emergency department. It discusses the consequences of stroke, definitions and types of stroke, signs and symptoms, risk factors, and the need for rapid recognition and treatment. For emergency management in the first 24 hours, it recommends using a stroke severity scale, performing brain imaging like CT or MRI within 20 minutes, considering thrombolysis if criteria are met, and following evidence-based guidelines to administer tPA within 4.5 hours of onset to improve outcomes. Timely evaluation, diagnosis and treatment are critical to minimize brain damage from stroke.
TIA and stroke prevention
1. A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with symptoms typically lasting less than one hour without evidence of acute infarction.
2. The risk of stroke is highest in the first few days after a TIA, with about a 10% risk of stroke in the first week and 15% risk within the first 90 days.
3. Evaluation of patients with suspected TIA involves detailed history, neurological exam, prognostic testing like the ABCD2 score, and investigations including blood tests, brain and vascular imaging to identify the cause and risk of future stroke.
Diagnosing Subarachnoid Haemorrhage in Neuro Critical Care
Join the debate between Bill Knight and Fernanda Bellolio as they go head-to-head, discussing diagnosing subarachnoid haemorrhage in neuro critical care headache. Should you rely on CT and lumbar puncture or, CT followed by CT angiogram.
Why should you care?
Acute headache accounts for 4% of all visits to the emergency departments. These patients will often describe the “Worst headache of life” – a phrase which can ring the alarm bells in the clincian’s mind. 88% of these will be from benign causes including migraine, tension and cluster. However 10% will have a subarachnoid haemorrhage, of which the vast majority are caused by an aneurysm.
These are frequently missed - up to 51% of the time in all settings and 6% of the time in the emergency department. It is in face one of the largest sources of US litigation claims and settlements.
So – what is the best way to diagnosis subarachnoid haemorrhage?
Bill asserts that the lumbar puncture (LP) following the CT is the way to go. He stresses that the “miss rate” needs to be 0% for subarachnoid haemorrhage. He argues that with the combination of CT and LP the sensitivity for subarachnoid haemorrhage is 100%
Fernanda on the other hand is a big proponent of using the combination of CT followed by CT angiogram (CTA). She discusses the very low incidence of subarachnoid haemorrhade and takes this into account when calculating the pre- and post-test probability for her patients. She argues that if the pre-test probability is higher for a patient, then a CTA can be utilised.
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myocardialinfarction-copy-130618222123-phpapp02.pptx
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Stroke imaging
- 3. Non contrast CT Scan in stroke • First line imaging modality for the evaluation of acute ischemic stroke. • Advantages: 1. Widespread availability 2. Short scan time 3. Non-invasive • The only limitation is limited sensitivity in the acute setting.
- 4. Goals of CT Scan in the acute setting 1. Exclude intracranial hemorrhage, which would preclude thrombolysis. 1. Look for any early features of infarction 1. Rule out any other intracranial pathologies that may mimic a stroke, such as tumors.
- 5. Stages • Early hyper-acute: < 6 hours • Late hyper-acute: 6 – 24 hours • Acute: 24 hours - 1 week • Subacute: 1 – 3 weeks • Chronic: > 3 weeks.
- 11. Subacute findings • As time goes on, the swelling starts to subside and the density increases due to small amounts of cortical petechial hemorrhages. (Fogging phenomenon) • Can mimic a normal CT Scan.
- 17. • Fluid attenuated inversion recovery MRI • Diffusion weighted MRI • Apparent diffusion coefficient MRI
- 18. Increased Intracranial Tension • normal ICP is 5 - 15 mmHg. • Causes of high ICP: 1. Head trauma 2. Hydrocephalus 3. Intracranial tumors 4. Hepatic encephalopathy 5. Cerebral edema
- 19. • Increased ICP can lead to death or devastating neurological damage by: 1. Reducing cerebral perfusion pressure (CPP) 2. Causing cerebral ischemia 3. Compressing and causing herniation of the brainstem or other vital structures. • Symptoms: 1. Headache (worse in the morning) 2. Projectile vomiting 3. Blurry vision 4. Altered level of consciousness 5. Cushing triad: Bradycardia + hypertension + irregular respiration.
- 20. Treatment • Elevate the head (promotes more venous drainage) • Diuretics: Mannitol • Hyperventilation • Sedation +/- muscle relaxants • Hemicraniotomy • Treat the underlying cause.