Slide 1
Imaging in ischemic strokeDR. SUNIL KUMAR SHARMASENIOR
RESIDENT,DEPT. OF NEUROLOGYG.M.C. & M.B.S. HOSPITAL, KOTA
Goals
Understand how imaging studies help in stroke diagnosis and
management through examining findings in patients at different
stages of ischemic stroke.Know the advantages of different tests in
ischemic stroke imaging.
StrokeStroke is a common term meaning a neurological condition
due to vascular lesions of the brain caused by hemorrahage,
embolism, thrombosis, or ruptured aneurysm.
Stroke Types
Most common stroke etiologies:1) Cerebral Infarction - 80%2)
Primary Intracranial Hemorrhage - 15%3) Nontraumatic subarachnoid
hemorrhage - 5%* FOCUS: Cerebral Infarction
Ischemic strokeIschemic stroke results because of significantly
diminished blood supply to all parts(global ischemia) or selected
areas(focal/regional)ischemia of the brain.Symptoms and clinical
behavior is determined by the vascular territory affected.
Ischemic stroke Large vessel occlusion(ICA,MCA,PCA)-40-50%Small
vessels (lacunar) infarct-25%Cardiac emboli (AF,MI,IE,mechanical
prosthetic heart valves,valvular heart disease,DCMP).-15%Blood
disorders- 5%.Nonatheromatous occlusion(e.g. vasculitis
,vasculopathy)-5%
Menu of Radiological Tests
CT: w/ or w/o contrastCT angiogram (CTA)CT perfusion imagingMR:
w/ or w/o contrastT1 or T2 weighted (T1WI, T2WI)FLAIRDiffusion
weighted image (DWI) SusceptibilityMR angiogramMR perfusion
imaging
CT Imaging of Cerebral InfarctsThe imaging manifestations of
cerebral ischemia vary significantly with time
8
CT w/o Contrast Test of Choice in Emergencies
1) Distinguish between ischemic and hemorrhagic stroke2) Normal
CT in patient with
