Clinical significance of detection of multiple acute brain infarcts on diffusion weighted magnetic resonance imaging (original) (raw)
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Magnetic Resonance Angiography and Brain Ischemia in Patients with Acute Stroke
2012
OBJECTIVE: The purpose of the study is to see presence of arterial diseases on Magnetic Resonance Angiography (MRA) and diffusion positive infarction in patients with acute ischemic stroke. STUDY DESIGN: Cross-sectional conducted at Radiology department of the Aga Khan University Hospital. METHODS: 124 patients with signs and symptoms of cerebral ischemia were referred for study. 16 patients could not complete the study because of poor cooperation and MRA was not done. 108 patients completed all sequences of the study according to departmental protocol. MRA findings were evaluated with presence of acute brain ischemia on magnetic resonance imaging. Chi square test was applied to see whether arterial disease on MRA correlated with brain parenchymal abnormality on MRI. p-value less than 0.05 were considered as significant. RESULTS: In majority of patients (95.34%) the arterial lesion on MRA correlated with acute infarction on MRI (p-value 0.001). 40 patients had arterial abnormality o...
Acute Cardioembolic Cerebral Infarction: Answers to Clinical Questions
Current Cardiology Reviews, 2012
Cardioembolic cerebral infarction (CI) is the most severe subtype of ischaemic stroke but some clinical aspects of this condition are still unclear. This article provides the reader with an overview and update of relevant aspects related to clinical features, specific cardiac disorders and prognosis of CI. CI accounts for 14 30% of ischemic strokes; patients with CI are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of CI, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke's aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The most common disorders associated with a high risk of cardioembolism include atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy and mitral rheumatic stenosis. Patent foramen ovale and complex atheromatosis of the aortic arch are potentially emerging sources of cardioembolic infarction. Mitral annular calcification can be a marker of complex aortic atheroma in stroke patients of unkown etiology. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. Magnetic resonance imaging, transcranial Doppler, and electrophysiological studies are useful to document the source of cardioembolism. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent. Dabigatran has been shown to be non-inferior to warfarin in the prevention of stroke or systemic embolism. All significant structural defects, such as atrial septal defects, vegetations on valve or severe aortic disease should be treated. Aspirin is recommended in stroke patients with a patent foramen ovale and indications of closure should be individualized. CI is an important topic in the frontier between cardiology and vascular neurology, occurs frequently in daily practice, has a high impact for patients, and health care systems and merits an update review of current clinical issues, advances and controversies.
Diffusion-Weighted Imaging Identifies a Subset of Lacunar Infarction Associated With Embolic Source
Stroke, 1999
Background and Purpose-Small infarcts in the territory of penetrator arteries were described as causing a number of distinct clinical syndromes. The vascular pathophysiology underlying such infarcts is difficult to ascertain without careful pathological study. However, the occurrence of multiple, small infarcts, linked closely in time but dispersed widely in the brain, raises the possibility of an embolic mechanism. The current study determines the frequency and clinical characteristics of patients with well-defined lacunar syndromes and the diffusion-weighted imaging (DWI) evidence of multiple acute lesions. Methods-Sixty-two consecutive patients who presented to the emergency room with a clinically well-defined lacunar syndrome were studied by DWI within the first 3 days of admission. Results-DWI showed multiple regions of increased signal intensity in 10 patients (16%). A hemispheric or brain stem lesion in a penetrator territory that accounted for the clinical syndrome ("index lesion") was found in all. DWI-hyperintense lesions other than the index lesion ("subsidiary infarctions") were punctate and lay within leptomeningeal artery territories in the majority. As opposed to patients with a single lacunar infarction, patients with a subsidiary infarction more frequently (PϽ0.05) harbored an identifiable cause of stroke.
Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment
Journal of Stroke, 2014
Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. For example, the high sensitivity and specificity of diffusionweighted image (DWI) can help distinguish acute ischemic stroke from stroke-mimics. Additionally, the lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent potential salvageable tissue by reperfusion therapy. However, the optimal threshold to discriminate between benign oligemic areas and the penumbra is still debatable. Signal changes of fluid-attenuated inversion recovery image within DWI lesions may be a surrogate marker for ischemic lesion age and might indicate risks of hemorrhage after thrombolysis. Clot sign on gradient echo image may reflect the nature of clot, and their location, length and morphology may provide predictive information on recanalization by reperfusion therapy. However, previous clinical trials which solely or mainly relied on perfusion-diffusion mismatch for patient selection, failed to show benefits of MRI-based thrombolysis. Therefore, understanding the clinical implication of various useful MRI findings and comprehensively incorporating those variables into therapeutic decision-making may be a more reasonable approach for expanding the indication of acute stroke thrombolysis.
Should computed tomography appearance of lacunar stroke influence patient management?
Journal of Neurology, Neurosurgery & Psychiatry, 1999
Patients with a lacunar stroke syndrome may have cortical infarcts on brain imaging rather than lacunar infarcts, and patients with the clinical features of a small cortical stroke (partial anterior circulation syndrome, PACS) may have lacunar infarcts on imaging. The aim was to compare risk factors and outcome in lacunar syndrome (LACS) with cortical infarct, LACS with lacunar infarct, PACS with cortical infarct, and PACS with lacunar infarct to determine whether the clinical syndrome should be modified according to brain imaging.
A case study: Multiple Lacunar Infarct using Magnetic Resonance Imaging
2021
Background: An ischemic stroke takes place when a blood vessel supplying the brain is blocked and blood circulation to a part of the brain is damaged. A lacunar stroke occurs due to one of the arteries that provide blood to the brain's deep structures is blocked. Case Study: A 55-year-old male patient have right cerebrovascular accident (CVA) with left hemiparesis on 16th of August 2019. Normal result was seen by brain Computed Tomography (CT) scanning. Magnetic Resonance Imaging (MRI) brain was done resulted in hyperintense lesion in right pons and foci and Magnetic Resonance Angiography (MRA) was done and resulted in severe basilar artery stenosis.
Epidemiological Study of the Patients Diagnosed as Ischemic Stroke in the Emergency Department
Journal of Academic Emergency Medicine, 2014
Objective: Stroke, heart disease and cancer is the third cause of death in the world and the most important reason of disability. To increase the level of one's living standards and treatment of cases of stroke, the epidemiological and etiological factors should be carefully examined and reported. Material and Methods: One hundred and two patients admitted to the emergency department and hospitalized in the neurology service were included the study. Their demographic properties, co-morbid diseases, laboratory results, electrocardiogram (ECG), computed tomography (CT), magnetic resonance imagining (MRI) a Doppler ultrasonography (USG) data were evaluated retrospectively. Results: Eighteen (17.6%) of the patients died during follow-up. Seventeen patients (16.7%) were regular smokers, and 4 (3.9%) used alcohol regularly. In 25 (24.5%) of the patients, atrial fibrillation was detected with ECG. In the echocardiographic examinations, 18 (24.3%) patients were shown to have an ejection fraction (EF) of less than 50%, while 6 patients were found to have less than 35% of EF. Ischemia could not be diagnosed with CT in 16 of the patients; the diagnoses of these patients were made using diffusion MRI. Doppler ultrasound examination of patients showed the following results: Complete or more than 50% occlusion was detected with Doppler USG in the right internal carotid artery (ICA) in 20.6%, and in the left ICA in 10.3%. Asymptomatic plaques were detected in the right common carotid artery in 54.4% of patients, and in the left common carotid artery in 50%. Conclusion: The early diagnosis and treatment of stroke and the preventable risk factors such as atrial fibrillation (AF), hypertension (HT), hyperlipidemia (HL) and diabetes mellitus (DM) will reduce morbidity associated with stroke.
Stroke, 1998
Background and Purpose-We sought to map early regional ischemia and infarction in patients with middle cerebral artery (MCA) stroke and compare them with final infarct size using advanced MRI techniques. MRI can now delineate very early infarction by diffusion-weighted imaging (DWI) and abnormal tissue perfusion by perfusion-weighted imaging (PWI). Methods-Seventeen patients seen within 12 hours of onset of MCA stroke had MR angiography, standard MRI, and PWI and DWI MRI. PWI maps were generated by analysis of the passage of intravenous contrast bolus through the brain. Cerebral blood volume (CBV) was determined after quantitative analysis of PWI data. Volumes of the initial DWI and PWI lesion were calculated and compared with a final infarct volume from a follow-up imaging study (CT scan or MRI). Results-Group 1 (10 patients) had MCA stem (M1) occlusion by MR angiography. DWI lesion volumes were smaller than the volumes of CBV abnormality. In 7 patients the final stroke volume was larger or the same, and in 3 it was smaller than the initial CBV lesion. Group 2 (7 patients) had an open M1 on MR angiography with distal MCA stroke. In 6 group 2 patients, the initial DWI lesion matched the initial CBV abnormality and the final infarct.