Clinical application of brain perfusion imaging in detecting stroke mimics: A review

Abstract

Stroke mimics constitute a significant proportion of patients with suspected acute ischemic stroke. These conditions may resemble acute ischemic stroke and demonstrate abnormalities on perfusion imaging sequences. The most common stroke mimics include seizure/epilepsy, migraine with aura, brain tumors, functional disorders, infectious encephalopathies, Wernicke's encephalopathy, and metabolic abnormalities. Brain perfusion imaging techniques, particularly computed tomography perfusion and magnetic resonance perfusion, are being widely used in routine clinical practice for treatment selection in patients presenting with large vessel occlusion. At the same time, the utilization of these imaging modalities enables the opportunity to better diagnose patients with stroke mimics in a time‐sensitive setting, leading to appropriate management, decision‐making, and resource allocation. In this review, we describe patterns of perfusion abnormalities that could discriminate patients with stroke mimics from those with acute ischemic stroke and provide specific case examples to illustrate these perfusion abnormalities. In addition, we discuss the challenges associated with interpretation of perfusion images in stroke‐related pathologies. In general, perfusion imaging can provide additional information in some cases—when used in combination with conventional magnetic resonance imaging and computed tomography—and might help in detecting stroke mimics among patients who present with acute onset focal neurological symptoms.

Current State of Evidence for Neuroimaging Paradigms in Management of Acute Ischemic Stroke

“…Other utilities of advanced imaging include helping with identification of medium vessel occlusions 114,115 and excluding stroke mimics. 116,117…”

“…They may also help with potential implementation of direct‐to‐angio suite workflow 110,111 when transfer times are reasonable and may facilitate mobile stroke intervention teams 112 and flying interventional teams, 113 discussed later. Other utilities of advanced imaging include helping with identification of medium vessel occlusions 114,115 and excluding stroke mimics 116,117 …”

Cerebrocardial Continuum in Patients After a Stroke

“…Мозок є одним із органів з найбільшою перфузією в організмі, і належне функціонування мозку вимагає, щоб церебральний кровотік підтримувався на постійному рівні незалежно від метаболічних потреб інших органів [1,2,26]. Шкідливий вплив ожиріння на мозкову судинну обумовлений тією обставиною, що пацієнти з ожирінням або пацієнти з підвищеним індексом маси тіла (ІМТ) мають знижений церебральний кровотік.…”