Imaging of acute ischemic stroke.

El-Koussy, Marwan; Schroth, Gerhard; Brekenfeld, Caspar; Arnold, Marcel (2014). Imaging of acute ischemic stroke. European neurology, 72(5-6), pp. 309-316. Karger 10.1159/000362719

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BACKGROUND Over 80% of strokes result from ischemic damage to the brain due to an acute reduction in the blood supply. Around 25-35% of strokes present with large vessel occlusion, and the patients in this category often present with severe neurological deficits. Without early treatment, the prognosis is poor. Stroke imaging is critical for assessing the extent of tissue damage and for guiding treatment. SUMMARY This review focuses on the imaging techniques used in the diagnosis and treatment of acute ischemic stroke, with an emphasis on those involving the anterior circulation. Key Message: Effective and standardized imaging protocols are necessary for clinical decision making and for the proper design of prospective studies on acute stroke. CLINICAL IMPLICATIONS Each minute without treatment spells the loss of an estimated 1.8 million neurons ('time is brain'). Therefore, stroke imaging must be performed in a fast and efficient manner. First, intracranial hemorrhage and stroke mimics should be excluded by the use of computed tomography (CT) or magnetic resonance imaging (MRI). The next key step is to define the extent and location of the infarct core (values of >70 ml, >1/3 of the middle cerebral artery (MCA) territory or an ASPECTS score ≤ 7 indicate poor clinical outcome). Penumbral imaging is currently based on the mismatch concept. It should be noted that the penumbra is a dynamic zone and can be sustained in the presence of good collateral circulation. A thrombus length of >8 mm predicts poor recanalization after intravenous thrombolysis.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

El-Koussy, Marwan; Schroth, Gerhard; Brekenfeld, Caspar and Arnold, Marcel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0014-3022

Publisher:

Karger

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

22 Jan 2015 12:06

Last Modified:

29 Oct 2015 11:44

Publisher DOI:

10.1159/000362719

PubMed ID:

25323674

BORIS DOI:

10.7892/boris.61850

URI:

https://boris.unibe.ch/id/eprint/61850

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