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Mimics of Acute Stroke: Tips and Tricks for Solving the Diagnostic Dilemma
Stroke affects approximately 800,000 people in the United States each year and is the fourth major leading cause of adult mortality.1 Rapid diagnostic evaluation and prompt treatment are important to prevent death and disability from a stroke. The literature suggests that up to 30% of patients who present with acute onset of neurologic symptoms were found to have a stroke misdiagnosis. In addition, the safety of thrombolytic therapy for stroke mimics has not been fully studied. Although patients with acute stroke can benefit substantially from thrombolytic therapy, misdiagnosis of acute stroke can carry serious implication...
Source: Contemporary Diagnostic Radiology - August 31, 2016 Category: Radiology Tags: Article Source Type: research

Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications.
CONCLUSION: The presence of SWI-DWI mismatch in acute MCA territory ischemic infarct is associated with smaller infarct volume. Moreover, SWI-DWI mismatch was associated with better outcome after correction for infarct size, severity of admission symptoms, and age. PMID: 27799573 [PubMed - as supplied by publisher]
Source: Acta Radiologica - October 30, 2016 Category: Radiology Authors: Payabvash S, Taleb S, Benson JC, Hoffman B, Oswood MC, McKinney AM, Rykken JB Tags: Acta Radiol Source Type: research

Topographic Assessment of Acute Ischemic Changes for Prognostication of Anterior Circulation Stroke
CONCLUSIONSTopographic assessment of acute ischemic changes using the sASPECTS (including caudate, lentiform nucleus, insula, and M5) can predict disability/death in anterior circulation stroke as accurately as the ASPECTS; and may help predict response to treatment and risk of developing symptomatic ICH.
Source: Journal of Neuroimaging - August 31, 2016 Category: Radiology Authors: Seyedmehdi Payabvash, Siamak Noorbaloochi, Adnan I. Qureshi Tags: Clinical Investigative Study Source Type: research

Timing of recanalization and outcome in ischemic-stroke patients treated with recombinant tissue plasminogen activator.
CONCLUSION: These data suggest that DR is associated with clinical deterioration. Patients treated with rtPA thrombolysis should be under close observation for 6-24 h. Corresponding treatment should be considered once DR appears. PMID: 25182802 [PubMed - as supplied by publisher]
Source: Acta Radiologica - September 2, 2014 Category: Radiology Authors: Wei XE, Zhao YW, Lu J, Li MH, Li WB, Zhou YJ, Li YH Tags: Acta Radiol Source Type: research

Comparison of susceptibility-weighted and perfusion-weighted magnetic resonance imaging in the detection of penumbra in acute ischemic stroke
Conclusions DWI-SWI mismatch is a good marker for evaluating ischemic penumbra in stroke patients with cerebral infarction. SWI can detect thrombus in the affected vessels, and may be useful for guiding intra-arterial thrombolytic therapy.
Source: Journal of Neuroradiology - August 14, 2015 Category: Radiology Source Type: research

Methotrexate-Induced Stroke-Like Encephalopathy: Beware the Stroke Mimic
We report a case of methotrexate (MTX)-induced stroke-like encephalopathy in an 18-year-old woman, with acute lymphoblastic leukemia, who developed a sudden neurological deficit mimicking a cerebrovascular event. Bain MRI showed hyperintensities on diffusion-weighted-imaging (DWI) with matching apparent diffusion coefficient hypointensities, which also represent the commonest MRI findings in acute cerebral infarction. DWI changes spared the cerebral cortex and did not respect vascular territories, supporting a non-vascular mechanism. MRI plays a crucial role in the diagnostic work-up   and is essential to avoid unnecessar...
Source: Journal of the Belgian Society of Radiology - October 31, 2022 Category: Radiology Source Type: research

Mobile Stroke Unit Reduces Time to Image Acquisition and Reporting INTERVENTIONAL
SUMMARY: Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy.
Source: American Journal of Neuroradiology - July 9, 2018 Category: Radiology Authors: Nyberg, E. M., Cox, J. R., Kowalski, R. G., Vela-Duarte, D., Schimpf, B., Jones, W. J. Tags: INTERVENTIONAL Source Type: research

Stroke and Stroke Mimics: A Pattern-Based Approach
“Stroke” is a general term that describes a clinical event characterized by a sudden onset of an acute neurologic deficit. Arterial ischemia comprises 80% of all strokes and is a leading cause of death and disability in the United States. Since the advent of thrombolytic therapy for ischemic stroke, rapid and accurate diagnosis has become essential.
Source: Seminars in Roentgenology - November 6, 2013 Category: Radiology Authors: Daniel J. Boulter, Pamela W. Schaefer Source Type: research

Pretreatment Advanced Imaging in Patients with Stroke Treated with IV Thrombolysis: Evaluation of a Multihospital Data Base BRAIN
CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.
Source: American Journal of Neuroradiology - March 13, 2014 Category: Radiology Authors: McDonald, J. S., Fan, J., Kallmes, D. F., Cloft, H. J. Tags: BRAIN Source Type: research

CT of the head for acute stroke: Diagnostic performance of a tablet computer prior to intravenous thrombolysis
ConclusionsTablet computers can be used to facilitate rapid preliminary CT interpretation in patients with acute stroke in the remote setting.
Source: Australasian Radiology - November 30, 2016 Category: Radiology Authors: Patrick D McLaughlin, Fiachra Moloney, Siobhan B O'Neill, Karl James, Lee Crush, Oisin Flanagan, Michael M Maher, Gerald Wyse, Noel Fanning Tags: Medical Imaging —Original Article Source Type: research

Endovascular thrombectomy for distal vessel occlusion stroke: Single-center experience
CONCLUSION: This single-center real-world experience demonstrates that EVT in patients with DVO stroke is safe and feasible and may lead to improved clinical outcome.PMID:36999213 | DOI:10.1177/15910199231162670
Source: Interventional Neuroradiology - March 31, 2023 Category: Radiology Authors: Stavros Matsoukas Santiago Gomez Paz Christopher P Kellner Reade De Leacy Johanna T Fifi J Mocco Shahram Majidi Source Type: research

MR Perfusion in the Evaluation of Mechanical Thrombectomy Candidacy
Stroke is a leading cause of disability and mortality, and the incidence of ischemic stroke is projected to continue to rise in coming decades. These projections emphasize the need for improved imaging techniques for accurate diagnosis allowing effective treatments for ischemic stroke. Ischemic stroke is commonly evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Noncontrast CT is typically used within 4.5 hours of symptom onset to identify candidates for thrombolysis. Beyond this time window, thrombolytic therapy may lead to poor outcomes if patients are not optimally selected using appropriate...
Source: Topics in Magnetic Resonance Imaging - August 1, 2021 Category: Radiology Tags: Review Articles Source Type: research

The Effects of DWI ‐Infarct Lesion Volume on DWI‐FLAIR Mismatch: Is There a Need for Size Stratification?
CONCLUSIONThe effects of stroke onset‐to‐scan time gap on DWI‐FLAIR mismatch are not the same for different DWI lesion volumes. At DWI lesion volumes >15 mL, the DWI‐FLAIR mismatch is highly specific for acute infarcts within IV thrombolytic therapy time, and can identify wake‐up stroke patients eligible for treatment.
Source: Journal of Neuroimaging - October 31, 2016 Category: Radiology Authors: Seyedmehdi Payabvash, Shayandokht Taleb, John C. Benson, Jeffrey B. Rykken, Mark C. Oswood, Alexander M. McKinney, Benjamin Hoffman Tags: Clinical Investigative Study Source Type: research

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