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Subacute Cerebral Infarction
Karen L. Salzman, MD; Sheri L. Harder, MD, FRCPC
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Subacute stroke, subacute cerebrovascular accident (CVA)
            • Definitions

              • Focal brain necrosis following obstruction of blood flow to localized area of brain
              • Subacute infarct ~ 2-14 days following initial ischemic event
              • May occur ± hemorrhagic transformation (HT)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Nuclear Medicine 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

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Zöllner JP et al: Changes of pH and energy state in subacute human ischemia assessed by multinuclear magnetic resonance spectroscopy. Stroke. 46(2):441-6, 2015
                                            2. Brunner IC et al: Plasticity and response to action observation: a longitudinal FMRI study of potential mirror neurons in patients with subacute stroke. Neurorehabil Neural Repair. 28(9):874-84, 2014
                                            3. Ntaios G et al: Acute imaging does not improve ASTRAL score's accuracy despite having a prognostic value. Int J Stroke. 9(7):926-31, 2014
                                            4. Qiao Y et al: Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images. Radiology. 271(2):534-42, 2014
                                            5. Yang YM et al: Normalization of T2 relaxation time and apparent diffusion coefficient in relation to the inflammatory changes in the substantia nigra of rats with focal cerebral ischemia. Acta Radiol. ePub, 2014
                                            6. Drier A et al: Prediction of subacute infarct size in acute middle cerebral artery stroke: comparison of perfusion-weighted imaging and apparent diffusion coefficient maps. Radiology. 265(2):511-7, 2012
                                            7. Kamalian S et al: CT perfusion mean transit time maps optimally distinguish benign oligemia from true "at-risk" ischemic penumbra, but thresholds vary by postprocessing technique. AJNR Am J Neuroradiol. 33(3):545-9, 2012
                                            8. Donnan GA et al: Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol. 8(3):261-9, 2009
                                            9. Elkind MS: Outcomes after stroke: risk of recurrent ischemic stroke and other events. Am J Med. 122(4 Suppl 2):S7-13, 2009
                                            10. Olivot JM et al: Perfusion MRI (Tmax and MTT) correlation with xenon CT cerebral blood flow in stroke patients. Neurology. 72(13):1140-5, 2009
                                            11. Muñoz Maniega S et al: Changes in NAA and lactate following ischemic stroke: a serial MR spectroscopic imaging study. Neurology. 71(24):1993-9, 2008
                                            12. Vernino S et al: Cause-specific mortality after first cerebral infarction: a population-based study. Stroke. 34(8):1828-32, 2003
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Subacute stroke, subacute cerebrovascular accident (CVA)
                                                      • Definitions

                                                        • Focal brain necrosis following obstruction of blood flow to localized area of brain
                                                        • Subacute infarct ~ 2-14 days following initial ischemic event
                                                        • May occur ± hemorrhagic transformation (HT)

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Angiographic Findings

                                                              • Nuclear Medicine 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

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Zöllner JP et al: Changes of pH and energy state in subacute human ischemia assessed by multinuclear magnetic resonance spectroscopy. Stroke. 46(2):441-6, 2015
                                                                                      2. Brunner IC et al: Plasticity and response to action observation: a longitudinal FMRI study of potential mirror neurons in patients with subacute stroke. Neurorehabil Neural Repair. 28(9):874-84, 2014
                                                                                      3. Ntaios G et al: Acute imaging does not improve ASTRAL score's accuracy despite having a prognostic value. Int J Stroke. 9(7):926-31, 2014
                                                                                      4. Qiao Y et al: Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images. Radiology. 271(2):534-42, 2014
                                                                                      5. Yang YM et al: Normalization of T2 relaxation time and apparent diffusion coefficient in relation to the inflammatory changes in the substantia nigra of rats with focal cerebral ischemia. Acta Radiol. ePub, 2014
                                                                                      6. Drier A et al: Prediction of subacute infarct size in acute middle cerebral artery stroke: comparison of perfusion-weighted imaging and apparent diffusion coefficient maps. Radiology. 265(2):511-7, 2012
                                                                                      7. Kamalian S et al: CT perfusion mean transit time maps optimally distinguish benign oligemia from true "at-risk" ischemic penumbra, but thresholds vary by postprocessing technique. AJNR Am J Neuroradiol. 33(3):545-9, 2012
                                                                                      8. Donnan GA et al: Penumbral selection of patients for trials of acute stroke therapy. Lancet Neurol. 8(3):261-9, 2009
                                                                                      9. Elkind MS: Outcomes after stroke: risk of recurrent ischemic stroke and other events. Am J Med. 122(4 Suppl 2):S7-13, 2009
                                                                                      10. Olivot JM et al: Perfusion MRI (Tmax and MTT) correlation with xenon CT cerebral blood flow in stroke patients. Neurology. 72(13):1140-5, 2009
                                                                                      11. Muñoz Maniega S et al: Changes in NAA and lactate following ischemic stroke: a serial MR spectroscopic imaging study. Neurology. 71(24):1993-9, 2008
                                                                                      12. Vernino S et al: Cause-specific mortality after first cerebral infarction: a population-based study. Stroke. 34(8):1828-32, 2003