Stroke imaging M3 radiology August 2014.

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Presentation transcript:

Stroke imaging M3 radiology August 2014

Why used in ED Add image Head CT

What can head CT show?

Hemorrhagic infarct

Normal

Vasogenic Cytotoxic

Large MCA Lev, Michael Radiology Oct 1999 p150-5 Look carefully with contrasty stroke windows to see subtle acute infarcts. This is a CTA. Works for CT nonconrast too. Still most acute infarcts not seen in first few hours. This does increase chance of seeing some acute infarcts by CT. Lev, Michael Radiology Oct 1999 p150-5

Motorstrip Where is the the bright gray matter not present? This is the acute infarct.

Motorstrip Where is the the bright gray matter not present? This is the acute infarct.

Non contrast Dense vessel and CT angiogram clot

Top of ICA clot? case

Clot on CTA

Case LP Now  One year prior

Basilar clot

Subacute or remote infarct

Take away White – Acute blood Black – Remote blood Normal – Acute infarct Black – Remote infarct Take away

Acute infarct CT vs MRI

Insular ribbon

Basal ganglia

one Acute and one Chronic

Subacute and remote infarcts

CTA

IV tPA

Endovascular tPA or mechanical

Timing

MRI

Neck Vessels CTA, MRA, US, Catheter