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Acute Ischemic Stroke
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Stroke, brain attack, cerebrovascular accident
            • Definitions

              • Interrupted blood flow to brain resulting in cerebral ischemia/infarction with variable neurologic deficit

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        Selected References

                                        1. Parrilla G et al: Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol. 33(9):1791-6, 2012
                                        2. Wang DJ et al: The value of arterial spin-labeled perfusion imaging in acute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced MRI. Stroke. 43(4):1018-24, 2012
                                        3. Harris AD et al: Diffusion and perfusion MR imaging of acute ischemic stroke. Magn Reson Imaging Clin N Am. 17(2):291-313, 2009
                                        4. Kranz PG et al: Does diffusion-weighted imaging represent the ischemic core? An evidence-based systematic review. AJNR Am J Neuroradiol. 30(6):1206-12, 2009
                                        5. Lee KY et al: Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke? Neurology. 72(13):1134-9, 2009
                                        6. Sanossian N et al: Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus. AJNR Am J Neuroradiol. 30(3):564-8, 2009
                                        7. Soares BP, Chien JD, Wintermark M. MR and CT monitoring of recanalization, reperfusion, and penumbra salvage: everything that recanalizes does not necessarily reperfuse! Stroke. 40(3 Suppl):S24-7, 2009
                                        8. Chen Z et al: Evaluating ischemic stroke with diffusion tensor imaging. Neurol Res. 30(7):720-6, 2008
                                        9. Provenzale JM et al: Optimization of perfusion imaging for acute cerebral ischemia: review of recent clinical trials and recommendations for future studies. AJR Am J Roentgenol. 191(4):1263-70, 2008
                                        10. Lell MM et al: New techniques in CT angiography. Radiographics. 26 Suppl 1:S45-62, 2006
                                        11. Bourekas EC et al: Intraarterial thrombolytic therapy within 3 hours of the onset of stroke. Neurosurgery. 54(1):39-44; discussion 44-6, 2004
                                        12. Diaz J et al: Cerebral ischemia: new risk factors. Cerebrovasc Dis. 17 Suppl 1:43-50, 2004
                                        13. Fiebach JB et al: Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke. 35(2):502-6, 2004
                                        14. Fiehler J et al: Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke. 35(2):514-9, 2004
                                        15. Gass A et al: Diffusion-weighted MRI for the "small stuff": the details of acute cerebral ischaemia. Lancet Neurol. 3(1):39-45, 2004
                                        16. Kelly PJ et al: Inflammation, homocysteine, and vitamin B6 status after ischemic stroke. Stroke. 35(1):12-5, 2004
                                        17. Kidwell CS et al: Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 292(15):1823-30, 2004
                                        18. Mahagne MH et al: Voxel-based mapping of cortical ischemic damage using Tc 99m L,L-ethyl cysteinate dimer SPECT in acute stroke. J Neuroimaging. 14(1):23-32, 2004
                                        19. Nakajima M et al: Relationships between angiographic findings and National Institutes of Health stroke scale score in cases of hyperacute carotid ischemic stroke. AJNR Am J Neuroradiol. 25(2):238-41, 2004
                                        20. Borisch I et al: Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. AJNR Am J Neuroradiol. 24(6):1117-22, 2003
                                        21. Eastwood JD et al: Quantitative assessment of the time course of infarct signal intensity on diffusion-weighted images. AJNR Am J Neuroradiol. 24(4):680-7, 2003
                                        22. Leary MC et al: Validation of computed tomographic middle cerebral artery "dot"sign: an angiographic correlation study. Stroke. 34(11):2636-40, 2003
                                        23. Tomandl BF et al: Comprehensive imaging of ischemic stroke with multisection CT. Radiographics. 23(3):565-92, 2003
                                        24. Toyoda K et al: Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia. AJNR Am J Neuroradiol. 22(6):1021-9, 2001
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Stroke, brain attack, cerebrovascular accident
                                                  • Definitions

                                                    • Interrupted blood flow to brain resulting in cerebral ischemia/infarction with variable neurologic deficit

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              Selected References

                                                                              1. Parrilla G et al: Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance. AJNR Am J Neuroradiol. 33(9):1791-6, 2012
                                                                              2. Wang DJ et al: The value of arterial spin-labeled perfusion imaging in acute ischemic stroke: comparison with dynamic susceptibility contrast-enhanced MRI. Stroke. 43(4):1018-24, 2012
                                                                              3. Harris AD et al: Diffusion and perfusion MR imaging of acute ischemic stroke. Magn Reson Imaging Clin N Am. 17(2):291-313, 2009
                                                                              4. Kranz PG et al: Does diffusion-weighted imaging represent the ischemic core? An evidence-based systematic review. AJNR Am J Neuroradiol. 30(6):1206-12, 2009
                                                                              5. Lee KY et al: Distal hyperintense vessels on FLAIR: an MRI marker for collateral circulation in acute stroke? Neurology. 72(13):1134-9, 2009
                                                                              6. Sanossian N et al: Angiography reveals that fluid-attenuated inversion recovery vascular hyperintensities are due to slow flow, not thrombus. AJNR Am J Neuroradiol. 30(3):564-8, 2009
                                                                              7. Soares BP, Chien JD, Wintermark M. MR and CT monitoring of recanalization, reperfusion, and penumbra salvage: everything that recanalizes does not necessarily reperfuse! Stroke. 40(3 Suppl):S24-7, 2009
                                                                              8. Chen Z et al: Evaluating ischemic stroke with diffusion tensor imaging. Neurol Res. 30(7):720-6, 2008
                                                                              9. Provenzale JM et al: Optimization of perfusion imaging for acute cerebral ischemia: review of recent clinical trials and recommendations for future studies. AJR Am J Roentgenol. 191(4):1263-70, 2008
                                                                              10. Lell MM et al: New techniques in CT angiography. Radiographics. 26 Suppl 1:S45-62, 2006
                                                                              11. Bourekas EC et al: Intraarterial thrombolytic therapy within 3 hours of the onset of stroke. Neurosurgery. 54(1):39-44; discussion 44-6, 2004
                                                                              12. Diaz J et al: Cerebral ischemia: new risk factors. Cerebrovasc Dis. 17 Suppl 1:43-50, 2004
                                                                              13. Fiebach JB et al: Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke. 35(2):502-6, 2004
                                                                              14. Fiehler J et al: Predictors of apparent diffusion coefficient normalization in stroke patients. Stroke. 35(2):514-9, 2004
                                                                              15. Gass A et al: Diffusion-weighted MRI for the "small stuff": the details of acute cerebral ischaemia. Lancet Neurol. 3(1):39-45, 2004
                                                                              16. Kelly PJ et al: Inflammation, homocysteine, and vitamin B6 status after ischemic stroke. Stroke. 35(1):12-5, 2004
                                                                              17. Kidwell CS et al: Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 292(15):1823-30, 2004
                                                                              18. Mahagne MH et al: Voxel-based mapping of cortical ischemic damage using Tc 99m L,L-ethyl cysteinate dimer SPECT in acute stroke. J Neuroimaging. 14(1):23-32, 2004
                                                                              19. Nakajima M et al: Relationships between angiographic findings and National Institutes of Health stroke scale score in cases of hyperacute carotid ischemic stroke. AJNR Am J Neuroradiol. 25(2):238-41, 2004
                                                                              20. Borisch I et al: Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. AJNR Am J Neuroradiol. 24(6):1117-22, 2003
                                                                              21. Eastwood JD et al: Quantitative assessment of the time course of infarct signal intensity on diffusion-weighted images. AJNR Am J Neuroradiol. 24(4):680-7, 2003
                                                                              22. Leary MC et al: Validation of computed tomographic middle cerebral artery "dot"sign: an angiographic correlation study. Stroke. 34(11):2636-40, 2003
                                                                              23. Tomandl BF et al: Comprehensive imaging of ischemic stroke with multisection CT. Radiographics. 23(3):565-92, 2003
                                                                              24. Toyoda K et al: Fluid-attenuated inversion recovery intraarterial signal: an early sign of hyperacute cerebral ischemia. AJNR Am J Neuroradiol. 22(6):1021-9, 2001