Stroke in Pregnancy and Review of Current Literature: Arterial Spin-Labeling MRI Can Identify the Presence and Intensity of Collateral Circle

Morello, Agnese; Casseri, Tommaso; Acampa, Maurizio; Galluzzi, Paolo; Cerase, Alfonso; Monti, Lucia

doi:10.1016/j.jstrokecerebrovasdis.2018.08.027

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…Thus, ASL is the MR perfusion technique of choice in pregnant women, children, and patients with gadolinium allergy. 5,41,42 Repetition of ASL acquisitions during a single study is also advantageous. 5 As technological advances occur, improved signal detection and ease of use will continue to increase interest in clinical applications of ASL imaging.…”

Section: Discussionmentioning

confidence: 99%

Arterial spin labeling clinical applications for brain tumors and tumor treatment complications: A comprehensive case-based review

et al. 2022

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Arterial spin labeling (ASL) is a noninvasive neuroimaging technique that allows for quantifying cerebral blood flow without intravenous contrast. Various neurovascular disorders and tumors have cerebral blood flow alterations. Identifying these perfusion changes through ASL can aid in the diagnosis, especially in entities with normal structural imaging. In addition, complications of tumor treatment and tumor progression can also be monitored using ASL. In this case-based review, we demonstrate the clinical applications of ASL in diagnosing and monitoring brain tumors and treatment complications.

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Section: Discussionmentioning

confidence: 99%

Arterial spin labeling clinical applications for brain tumors and tumor treatment complications: A comprehensive case-based review

et al. 2022

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“…Gadolinium is a class C drug; its use is not recommended during gestation as it crosses the placenta and has been associated with teratogenesis in animal studies (84). Additional techniques potentially of use in this population include MRI with arterial spin labeling, which avoid the use of ionizing radiation or contrast, instead using the patient's own blood as the "contrast" agent and providing a map of the collateral circulation, areas of occlusion and perfusion maps (85,86).…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Maternal Stroke: an Update

Zambrano

Miller

2019

Curr Atheroscler Rep

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Purpose of the review: Maternal morbidity and mortality is rising in the United States, and maternal stroke is a major contributor. Here, we review the epidemiology, risk factors and current recommendations for diagnosis and acute treatment of ischemic and hemorrhagic stroke during pregnancy and postpartum, focusing on recent evidence. Recent findings:The incidence of maternal stroke has risen in recent years, possibly due to increasing rates of hypertensive disorders of pregnancy. The risk of maternal stroke is highest in the peripartum and early postpartum period. Preeclampsia is highly associated with reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome, and is also associated with long-term increased risk of stroke and vascular dementia. Hypertensive disorders of pregnancy, migraine, and infections are risk factors for maternal stroke. Limited data suggest that thrombolytics and endovascular reperfusion therapy are safe and effective in pregnant women with ischemic stroke, but few data are available regarding safety of thrombolytics in the postpartum period. New consensus guidelines are now available to assist with management of ischemic and hemorrhagic stroke in pregnancy.Summary: Many gaps remain in our understanding of maternal stroke. While risk factors have been identified, there are no prediction tools to help identify which women might be at highest risk for postpartum stroke and require closer monitoring. The risk of recurrent maternal stroke has not been adequately quantified, limiting clinicians' ability to counsel patients. The complex pathophysiology of preeclampsia and its effects on the cerebral vasculature require further targeted study. An increased focus on the prevention, recognition, and optimal treatment of maternal stroke will be critical to reducing maternal morbidity and mortality.

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Stroke Mimics: Insights from a Retrospective Neuroimaging Study

Lucia,

Davide,

Francesca

et al. 2023

J Neurosci Neurol Disord

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Objectives: The study’s goals are to evaluate the management of Stroke Mimics (SMs), conditions with stroke-like symptoms but non-vascular origins. It seeks to assess the effect of unnecessary intravenous thrombolysis on therapy delays and determine the best SMs diagnosis approach. Materials and methods: A review was conducted of all patients admitted to the Emergency Department under a “stroke code” from January 1, 2018, to January 31, 2019. Anamnestic and clinical data, along with information on neuroimaging protocols and findings, were collected. Advanced MRI sequences, such as Arterial Spin Labeling (ASL) MR perfusion and MR spectroscopy, were revised to confirm the diagnoses. Results: 513 stroke codes were found; a neurovascular disease was diagnosed in 414 cases: 282 ischemic strokes and 73 intracranial hemorrages and 59 TIAs. The 99 SMs included, 13 infections, 12 syncopes, 11 epileptic seizures, 11 hemodinamic conditions, 10 tumors, 9 metabolic disorders, 9 diziness, 7 migraines, 4 drug/alcohol intoxication, 3 functional disorders, 3 acute hydrocefalus, 2 multiple sclerosis, 2 arteriovenous malformations, 1 spinal cord compression and 2 unexplained conditions. Specific neuroimaging findings were evaluated for all cases. Positive and negative predictive values of clinical diagnosis of SM were respectively 0.23 and 0.35. 125 SM patients underwent MRI examination, 40 of which within 3 hours from the activation of stroke code. Advanced MRI sequences as ASL, MR perfusion, MR spectroscopy were used to reach the correct diagnosis. Conclusions: Advanced multimodal MRI can be a valuable tool in the assessment of, particularly in cases where conventional imaging techniques such as DWI-FLAIR mismatch are inconclusive. The novelty of this retrospective study is to demonstrate that the consistent use of arterial spin labeling perfusion in cases with stroke code leads to a rapid and accurate diagnosis of SMs. The implementation of an MRI-based pathway can expedite the diagnosis and treatment of underlying non-vascular causes such as SMs.

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Stroke in Pregnancy and Review of Current Literature: Arterial Spin-Labeling MRI Can Identify the Presence and Intensity of Collateral Circle

Cited by 4 publications

References 11 publications

Arterial spin labeling clinical applications for brain tumors and tumor treatment complications: A comprehensive case-based review

Arterial spin labeling clinical applications for brain tumors and tumor treatment complications: A comprehensive case-based review

Maternal Stroke: an Update

Stroke Mimics: Insights from a Retrospective Neuroimaging Study

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