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A radiologist’s guide to the clinical scales used in the 2015 Endovascular Stroke Trials and the Revised American Heart Association/American Stroke Association Guidelines for Endovascular Stroke Treatment
Abstract In 2015, five trials demonstrated the efficacy of endovascular treatment for acute stroke, culminating in the revised American Heart Association/American Stroke Association (AHA/ASA) recommendations for stroke management. The different clinical scales used in these trials may be unfamiliar to emergency and on-call radiologists. The modified Rankin Scale was used to describe patient disability for prestroke assessment in three of the trials and for the 90-day follow up in all five trials. The Barthel index was used in one trial to score prestroke ability to perform activities of daily living. The NIH Strok...
Source: Emergency Radiology - July 6, 2016 Category: Emergency Medicine Source Type: research

A radiologist ’s guide to the clinical scales used in the 2015 Endovascular Stroke Trials and the Revised American Heart Association/American Stroke Association Guidelines for Endovascular Stroke Treatment
Abstract In 2015, five trials demonstrated the efficacy of endovascular treatment for acute stroke, culminating in the revised American Heart Association/American Stroke Association (AHA/ASA) recommendations for stroke management. The different clinical scales used in these trials may be unfamiliar to emergency and on-call radiologists. The modified Rankin Scale was used to describe patient disability for prestroke assessment in three of the trials and for the 90-day follow up in all five trials. The Barthel index was used in one trial to score prestroke ability to perform activities of daily living. The NIH Stroke Scale ...
Source: Emergency Radiology - July 6, 2016 Category: Emergency Medicine Source Type: research

An acute stroke CT imaging algorithm incorporating automated perfusion analysis
AbstractIn this paper, we propose a CT imaging algorithm for patients presenting with suspected acute stroke that incorporates automated CT perfusion  (CTP) imaging. The algorithm details evaluation of the non-contrast CT (NCCT) for hemorrhage and acute ischemia, calculation of ASPECTS, with performance and interpretation of CTP if appropriate. In particular, we consider the key steps in expeditious interpretation of non-contrast CT and CT angi ography in the context of suspected acute ischemic stroke. Given the recent expansion of the “imaging based” treatment window for thrombectomy from 6 to 24 h in the 2018 Amer...
Source: Emergency Radiology - February 1, 2019 Category: Emergency Medicine Source Type: research

What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke?
The objective of this study is to detect the subgroup of patients with such presentations having minor strokes whom may benefit from primary and secondary stroke prevention. We conducted a retrospective analysis and stratified patient risk factors associated with positive findings on subsequent head MRI ordered by the emergency department physician following a normal head CT. Two hundred fifty-two patients presenting with atypical stroke symptoms to the emergency department had a negative head CT followed by head MRI within 24 h ordered by emergency department clinician (123 males and 129 females; mean age of 59.4). Twent...
Source: Emergency Radiology - May 23, 2016 Category: Emergency Medicine Source Type: research

Imaging of acute ischemic stroke
This article reviews the various imaging modalities and techniques employed in the imaging of AIS patients, with an emphasis on recommendations from recent randomized contr olled trials and national consensus guidelines.
Source: Emergency Radiology - July 6, 2018 Category: Emergency Medicine Source Type: research

Imaging in neurointerventional stroke treatment: review of the recent trials and what your neurointerventionalist wants to know from emergency radiologists
This article summarizes the use of imaging in recent stroke trials in details, provides a stroke imaging protocol, and provides tips which radiologists should know to help their neurointerventionalists.
Source: Emergency Radiology - December 14, 2018 Category: Emergency Medicine Source Type: research

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke
ConclusionsThe increase in detection rate for BCVI justifies more liberal screening protocols.
Source: Emergency Radiology - February 12, 2019 Category: Emergency Medicine Source Type: research

Clinical conundrum: concomitant high-risk pulmonary embolism and acute ischemic stroke
AbstractHigh-risk PE can be complicated by the presence of a patent foramen ovale (PFO), which can lead to paradoxical systemic embolization, including cerebral embolism ultimately leading to acute ischemic stroke (AIS). Acute management is challenging given the competing benefits and risks of systemic thrombolysis. Herein, we aim to provide a review of clinical presentations, diagnostic findings, and treatment and outcome from the available literature, with the hopes of providing insight into treatment options. We followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (P...
Source: Emergency Radiology - March 23, 2020 Category: Emergency Medicine Source Type: research

Implementation of emergent MRI for wake-up stroke: a single-center experience
ConclusionIn this “real world” assessment of incorporation of emergent MRI for wake-up strokes, there were several key factors to successful implementation of this new workflow, including effective and accurate description of MRI findings; close collaboration amongst stakeholders; 24/7 availability of MRI; and 24 /7 onsite coverage by neurology and radiology physicians.
Source: Emergency Radiology - June 30, 2021 Category: Emergency Medicine Source Type: research

Utilization of CT angiography of the head and neck in the era of endovascular therapy for acute ischemic stroke: a retrospective study
ConclusionLittle is known of the impacts on healthcare resources that have resulted from the system-wide changes made necessary by the widespread adoption of EVT. Our study shows that at our site, these system changes have resulted in large increases in CTA utilization with very small numbers of patients ultimately undergoing EVT or carotid intervention.
Source: Emergency Radiology - March 12, 2022 Category: Emergency Medicine Source Type: research

Misleading CT perfusion in subacute ischemic stroke
AbstractThe RAPID © software is the most commonly used computed tomography perfusion (CTP) software in stroke centers. It is estimated that about 1300 hospitals in the world are using this software for decision-making in ischemic stroke. The software provides the estimated volume of infarction and ischemic penumbra, so it is the backbone of treatment planning in these patients. In this manuscript, we present two cases of subacute infarction with misleading CTP using RAPID© software. We believe that given the popularity of this software and increasing application of CTP in subacute infarction, this pitfall is likely under...
Source: Emergency Radiology - August 19, 2019 Category: Emergency Medicine Source Type: research

Neurological emergencies associated with COVID-19: stroke and beyond
We report five cases of COVID-19 presenting to the ER with acute neurological symptoms, over the course of 1  month. This includes two cases of ischemic stroke, one with large-vessel occlusion and one with embolic infarcts. The remainders of the cases include acute tumefactive demyelination, isolated cytotoxic edema of the corpus callosum with subarachnoid hemorrhage, and posterior reversible encephalopat hy syndrome (PRES).
Source: Emergency Radiology - August 10, 2020 Category: Emergency Medicine Source Type: research

Optimal slice thickness of brain computed tomography using a hybrid iterative reconstruction algorithm for identifying hyperdense middle cerebral artery sign of acute ischemic stroke
ConclusionThin slice thickness of ≤ 1 mm has a better diagnostic performance for identifying hyperdense artery sign on brain non-contrast computed tomography with a hybrid iterative reconstruction algorithm in patients with acute ischemic stroke.
Source: Emergency Radiology - October 14, 2020 Category: Emergency Medicine Source Type: research

Role of prothrombin complex concentrate (PCC) in Acute Intracerebral Hemorrhage with Positive CTA spot sign: An institutional experience at a regional and state designated stroke center
ConclusionsWe found a strong statistical correlation favoring our hypothesis. Use of PCC in active ICH with positive CTASS resulted in overall decrease in the mean hematoma size at 24  h, whereas the control group showed an overall increase.
Source: Emergency Radiology - December 2, 2016 Category: Emergency Medicine Source Type: research

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