Renal Safety of CT Angiography and Perfusion Imaging in the Emergency Evaluation of Acute Stroke

Hopyan, Julia; Gladstone, David J.; Mallia, Gabriella; Schiff, Jeffrey; Fox, Allan J.; Symons, Sean; Buck, Brian; Black, Sandra E.; Aviv, Richard I.

doi:10.3174/ajnr.a1257

Cited by 120 publications

(84 citation statements)

References 30 publications

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“…In most centres, computed tomographic angiography (CTA) is the modality of choice owing to widespread availability, speed of image acquisition, and minimal contraindications in patients without renal impairment. 17 It is important to note that neither CT nor CTA is highly sensitive for the diagnosis of acute posterior fossa ischemic stroke; one study found that only 33% of acute MRI-confirmed brainstem infarctions were detected by CT.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good. RÉ SUMÉLes patients qui souffrent du syndrome bulbaire laté ral pré sentent gé né ralement des troubles hé misensoriels croisé s, un syndrome de Claude Bernard-Horner homolaté ral et des signes cé ré belleux, manifestations qui ré sultent toutes d'un infarctus du bulbe laté ral. Toutefois, le tableau clinique habituel du syndrome est variable, comme en té moignent un exposé de cas et l'examen de la documentation. Nous ferons donc é tat de l'approche diagnostique et de la prise en charge du syndrome bulbaire laté ral, et soulignerons la né cessité de rassembler tous les renseignements d'ordre clinique et de les mettre en relation avec l'anatomie du tronc cé ré bral afin de distinguer les patients devant subir d'urgence des examens en neuro-imagerie et des traitements pour un accident vasculaire cé ré bral. L'association entre l'infarctus du bulbe laté ral et la dissection de l'artè re verté brale fait ressortir l'importance de reconnaître cette premiè re affection au service des urgences. Moyennant le meilleur traitement possible, le syndrome bulbaire laté ral porte un pronostic favorable quant au ré tablissement.

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Section: Diagnosis and Managementmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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“…The use of this technique is supported by the current literature 4,[6][7][8][9] . Delgado-Almandoz et al 4,15 defined CTA-SI parameters appropriate for the diagnosis of the spot sign within ICH.…”

Section: Discussionmentioning

confidence: 73%

“…This imaging sign has also been reproduced on MDCT angiography as a robust predictor of expansion and as an indicator of worse prognosis and mortality 3,4 . MDCT angiography has been proven to be a rapid and reproducible alternative to catheter angiography that reduces the risks to the enrolled patients and offers significant benefits to the decision-making process [6][7][8][9] . A higher incidence of hemorrhagic stroke has been repor ted in the Latin American population [10][11][12][13] .…”

mentioning

confidence: 99%

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

Rosa

Rocha

Saade

et al. 2013

Arq. Neuro-Psiquiatr.

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Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.

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“…CT angiography is a less invasive and valuable tool in the diagnosis of vascular pathologies, and has spread rapidly with the application of new technologies, such as multi-detector CT. 8,14) One of the advantages of this method is that comprehensive vascular anatomic data can be obtained in a single examination. Thus, useful and important information for planning the treatment strategy can be provided by mapping out the arterial anatomy prior to intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies focusing on imaging with contrast medium demonstrated much lower incidence of renal failure due to contrast medium-induced nephropathy. 8,9) However, we should perform CT angiography with a protocol intended to decrease intravenous administration of contrast medium as much as possible.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Computed Tomography Angiography for the Detection of High-Risk Aortas for Carotid Artery Stenting

Yamamoto

Kuwayama

Hayashi

et al. 2011

Neurol. Med. Chir.(Tokyo)

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This study evaluated the usefulness of computed tomography (CT) angiography for the detection of high-risk aortas for carotid artery stenting (CAS). We investigated changes in the treatment method and modifications of endovascular techniques according to the information from CT angiography. CT angiography using three-dimensional and multi-planar reconstruction was performed in 43 consecutive patients with carotid artery stenoses intended to undergo CAS. Two neurosurgeons evaluated the images and estimated the risk and difficulties of CAS. CT angiography clearly depicted the entire aorta, the supra-aortic vessels, and the ilio-femoral arteries in all patients. Abnormal vascular findings were found in 17 patients. High-risk aortic lesions for CAS were detected in 5 patients, including thick aortic plaques with thrombi in 2. We changed the treatment strategy from CAS to carotid endarterectomy (CEA) in these 2 patients. CT angiograms proved very useful in evaluating the approach routes of CAS in 12 patients. One patient had dissecting aneurysm of the thoracic aorta and another had aberrant right vertebral artery. In these two, the treatment strategy was changed from CAS to CEA. The treatment method was changed in 4 patients in total. CT angiography is useful for the detection of high-risk aortas for CAS and for the evaluation of safe approaches to the carotid artery.

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Renal Safety of CT Angiography and Perfusion Imaging in the Emergency Evaluation of Acute Stroke

Cited by 120 publications

References 30 publications

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

Usefulness of Computed Tomography Angiography for the Detection of High-Risk Aortas for Carotid Artery Stenting

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