Magnetic Resonance Imaging in Acute Ischemic Stroke Treatment

Abstract

Although intravenous administration of tissue plasminogen activator is the only proven treatment after acute ischemic stroke, there is always a concern of hemorrhagic risk after thrombolysis. Therefore, selection of patients with potential benefits in overcoming potential harms of thrombolysis is of great importance. Despite the practical issues in using magnetic resonance imaging (MRI) for acute stroke treatment, multimodal MRI can provide useful information for accurate diagnosis of stroke, evaluation of the risks and benefits of thrombolysis, and prediction of outcomes. For example, the high sensitivity and specificity of diffusion-weighted image (DWI) can help distinguish acute ischemic stroke from stroke-mimics. Additionally, the lesion mismatch between perfusion-weighted image (PWI) and DWI is thought to represent potential salvageable tissue by reperfusion therapy. However, the optimal threshold to discriminate between benign oligemic areas and the penumbra is still debatable. Signal changes of fluid-attenuated inversion recovery image within DWI lesions may be a surrogate marker for ischemic lesion age and might indicate risks of hemorrhage after thrombolysis. Clot sign on gradient echo image may reflect the nature of clot, and their location, length and morphology may provide predictive information on recanalization by reperfusion therapy. However, previous clinical trials which solely or mainly relied on perfusion-diffusion mismatch for patient selection, failed to show benefits of MRI-based thrombolysis. Therefore, understanding the clinical implication of various useful MRI findings and comprehensively incorporating those variables into therapeutic decision-making may be a more reasonable approach for expanding the indication of acute stroke thrombolysis.

The Capillary Index Score before thrombectomy: an angiographic correlate of favorable outcome

“…Although our data cannot provide evidence of this hypothesis by comparing CIS with perfusion weighted imaging (PWI) or volume of infarction on diffusion weighted imaging (DWI),7 8 several arguments are consistent with this hypothesis. Firstly, the lack of enhancement of the brain at the capillary phase—which defines a poor CIS—is due to either a severe decrease in cerebral blood volume and/or a significant increase in mean transit time.…”

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

“…In the previous studies, 9% [11] and 21% [12] of the patients with LMI were reported to accompany cerebellar infarcts, and MRI was used in 67 and 100% of these patients respectively. The relatively high proportion of LMI-plus in our series may be attributed to (1) the inclusion of patients with extra-cerebellar lesions and (2) our use of DWI that can reliably locate acute small infarcts in the posterior circulation territory [13]. …”

Disability caused by post-stroke visual impairment as an underestimated clinical problem — case report

“…Similar to the cases of logotherapy in patients with speech disorders or early kinesitherapy in patients with motor dysfunction, visual impairments require complex management [9][10][11][12]. It is essential that patients with visual disorders are thoroughly examined by a neurologist and ophthalmologist and undergo follow-up neuroimaging visualising and assessing the extent of cerebral stroke (preferably using MRI) as well as perimetry tests [13][14][15]. Complex medical attention, objectivisation of disorders, and evaluation of prognosis favourably affect the patient`s mental condition, which prevents reactive mood disorders enhancing disability [16].…”