Realguitar Stroke Map

  1. Realguitar Stroke Map In Texas
  2. Realguitar Stroke Map In India
Dr Michael Stewart ◉ ◈ and Dr Sandeep Bhuta et al.
Stroke

Diffusion weighted imaging (DWI) is a commonly performed MRI sequence for evaluation of acute ischemic stroke, and is sensitive in the detection of small and early infarcts. Conventional MRI sequences (T1WI, T2WI) may not demonstrate an infarct for 6 hours, and small infarcts may be hard to appreciate on CT for days, especially without the benefit of prior imaging.

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Increased DWI signal in ischemic brain tissue is observed within a few minutes after arterial occlusion and progresses through a stereotypic sequence of apparent diffusion coefficient (ADC) reduction, followed by subsequent increase, pseudo-normalization and, finally, permanent elevation. Reported sensitivity ranges from 88-100% and specificity ranges from 86-100%.

For a general discussion of the pathogenesis and radiographic features please refer to ischemic stroke.

Radiographic features

The appearance of DWI/ADC depends on the timing.

Acute (0-7 days)
  • ADC value decreases with maximal signal reduction at 1 to 4 days
  • marked hyperintensity on DWI (a combination of T2 and diffusion weighting), less hyperintensity on exponential images, and hypointensity on ADC images
  • subsequently, release of inflammatory mediators from ischemic brain tissue leads to vasogenic edema with extravasation of water molecules from blood vessels to expand the interstitial space, where water molecule diffusion is highly unrestricted
  • early DWI reversal (aka diffusion lesion reversal) can occur, most frequently with reperfusion, but this rarely alters the size of the eventual infarct and is probably a 'pseudoreversal' 3-5.

Realguitar Stroke Map In Texas

Subacute (1-3 weeks)
  • ADC pseudonormalization occurs in the second week (7-15 days)
    • ADC values rise and return to near baseline
    • irreversible tissue necrosis is present despite normal ADC values
    • DWI remains hyperintense due to T2 shine through
  • after 2 weeks ADC values continue to rise above normal parenchyma and the region appears hyperintense 2
Chronic (>3 weeks)
  • ADC signal high
  • DWI signal low (as T2 hyperintensity and thus T2 shine through resolve)
  • 1. Srinivasan A, Goyal M, Al azri F et-al. State-of-the-art imaging of acute stroke. Radiographics. 2006;26 Suppl 1 : S75-95. doi:10.1148/rg.26si065501 - Pubmed citation
  • 2. Allen LM, Hasso AN, Handwerker J et-al. Sequence-specific MR Imaging Findings That Are Useful in Dating Ischemic Stroke. Radiographics. 2012;32 (5): 1285-97. doi:10.1148/rg.325115760 - Pubmed citation
  • 3. Campbell BC, Purushotham A, Christensen S et-al. The infarct core is well represented by the acute diffusion lesion: sustained reversal is infrequent. J. Cereb. Blood Flow Metab.32 (1): 50-6. doi:doi:10.1038/jcbfm.2011.102 - Free text at pubmed - Pubmed citation
  • 4. Grant PE, He J, Halpern EF et-al. Frequency and clinical context of decreased apparent diffusion coefficient reversal in the human brain. Radiology. 2001;221 (1): 43-50. doi:10.1148/radiol.2211001523 - Pubmed citation
  • 5. Inoue M, Mlynash M, Christensen S et-al. Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3 to 6 hours after onset. Stroke. 2014;45 (4): 1024-8. doi:10.1161/STROKEAHA.113.002135 - Free text at pubmed - Pubmed citation

Related Radiopaedia articles

Stroke and intracranial haemorrhage
  • stroke and intracranial hemorrhage
    • ischemic stroke
      • general discussions
        • CT perfusion
        • DWI in acute stroke
      • scoring and classification systems
        • Alberta stroke program early CT score (ASPECTS)
        • thrombolysis in cerebral infarction (TICI)
        • collateral vessel scores
      • signs
      • by region
        • hemispheric infarcts
          • frontal lobe infarct
          • parietal lobe infarct
          • temporal lobe infarct
          • occipital lobe infarct
            • alexia without agraphia syndrome: PCA
            • cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
            • Balint syndrome: bilateral PCA
        • lacunar infarct
        • thalamic infarct
          • Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
        • brainstem infarct
          • midbrain infarct
            • Benedikt syndrome: PCA
            • Claude syndrome: PCA
            • Nothnagel syndrome: PCA
            • Weber syndrome: PCA
          • pontine infarct
            • Gasperini syndrome: basilar artery or AICA
            • inferior medial pontine syndrome (Foville syndrome): basilar artery
            • lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
            • locked-in syndrome: basilar artery
            • Millard-Gubler syndrome: basilar artery
            • Raymond syndrome: basilar artery
          • medullary infarct
            • hemimedullary syndrome (Reinhold syndrome)
            • lateral medullary stroke syndrome (Wallenberg syndrome)
            • medial medullary syndrome (Déjerine syndrome)
        • acute spinal cord ischemia syndrome
      • by vascular territory
        • anterior circulation infarction
          • middle cerebral artery infarct
        • posterior circulation infarction
          • posterior cerebral artery infarct
          • brainstem infarct
          • cerebellar infarction
      • treatment options
      • complications
        • hemorrhagic transformation of an ischemic infarct
    • intracranial hemorrhage
      • intra-axial hemorrhage
        • signs and formulas
          • ABC/2 (volume estimation)
        • by region or type
          • cerebellar hemorrhage
          • ​hemorrhagic venous infarct
          • hemorrhagic transformation of an ischemic infarct
          • lobar hemorrhage
          • pontine hemorrhage
      • extra-axial hemorrhage
        • extradural hemorrhage (EDH)
        • subdural hemorrhage (SDH)
        • subarachnoid hemorrhage (SAH)
          • types
            • ruptured berry aneurysm
          • grading systems

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Realguitar Stroke Map In India

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