Stroke and Brain Parenchyma

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Stroke and Cerebrum Parenchyma. Nima Aghaebrahim August 28, 2008. Stroke. Third driving reason for death and driving reason for incapacity in the U.S. Rate: 700,000 every year and expanding around one stroke each moment Like clockwork, somebody kicks the bucket of a stroke Objective of imaging:

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Stroke and Brain Parenchyma Nima Aghaebrahim August 28, 2008

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Stroke Third driving reason for death and driving reason for handicap in the U.S. Frequency: 700,000 every year and expanding around one stroke each moment Every 3.3 minutes, somebody kicks the bucket of a stroke Goal of imaging: Establish finding quick Obtain precise data in regards to intracranial vasculature and mind perfusion Appropriate treatment

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Goals of Acute Stroke Imaging 4 Ps Parenchyma: Assess early indication of intense stroke, preclude discharge (unenhanced CT) Pipes: Assess extracranial course (carotid and vertebral corridors of the neck) Assess intracranial dissemination for proof of intravascular thrombus Perfusion: Assess Cerebral blood volume, cerebral blood stream, and mean travel time Penumbra: survey tissue at danger of biting the dust if ischemia proceeds without recanalization of intravaslular thrombus

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It is about the Penumbra! At the point when a cerebral course is impeded, a center of cerebrum tissue passes on quickly (irreversible) Surrounding this infarct center is a range of mind that is hypoperfused yet does not bite the dust rapidly, due to insurance blood stream, This encompassing region is penumbra (salvageable) Its destiny rely on upon the reperfusion of the ischemic cerebrum Will likewise bite the dust unless early recanalization is available Thrombolysis by means of tPA, thrombus expulsion, and so on

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Imaging alternatives Unenhanced CT: discount discharge Not great to recognize ischemia T1 or T2 weighted MRI Good to detect ischemia Cannot separate between intense versus perpetual ischemia So we have…

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Diffusion-weighted MR More delicate for recognition of hyperacutre ischemia gets to be distinctly anomalous inside 30 minutes Distinguish b/w old and new stroke New stroke: brilliant on DWI Old stroke: Low SI on DWI It identifies irreversible infarcted tissue

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Physiology Ischemia  deficiency of metabolites Na+/K+ divert disappointment in the phone Cause cytotoxic edema: move of water into intracellular compartment Leads to a narrowing of the extracellular network Restricted dissemination of water inside the phone Increase flag which can be measured with DWI

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MRI OLD – VS-NEW ISCHEMIC INFARCT T1 T2 DIFFUSION

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Perfusion-Weighted imaging Allows the estimation of hairlike perfusion of the cerebrum Uses a MR differentiate operator The complexity bolus entry causes a nonlinear flag diminish in extent to the perfusion cerebral blood volume Meaning, it can recognize zones of hypoperfusion, the reversible ischemia, also (dissimilar to DWI)

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Comparison of PWI and DWI  irreversibly harmed infarct PWI  mirrors the entire region of hypoperfusion The volume contrast between these two, the PWI/DWI crisscross would be the PENUMBRA! In the event that there is no distinction in PWI and DWI, no penumbra is available

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Significance of PWI/DWI confound IV thrombolytic treatment is not normally managed to patients with intense stroke past 3-hrs period Risk of drain However, late reviews have demonstrated that IV thrombolytic treatment may profit patients who are painstakingly chosen by PWI/DWI confuse, past 3-hrs window

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Acute stroke in a 67-year-old lady with intense left hemiplegia 2 hours after carotid endarterectomy. (a) Diffusion-weighted MR picture demonstrates a zone of somewhat expanded flag power in the privilege parietal flap (bolts). The ADC values in this locale were diminished. (b) Perfusion-weighted MR picture demonstrates a bigger region with expanded time to top upgrade (bolts) in the privilege cerebral half of the globe. The jumble between the perfusion and dissemination pictures is characteristic of an extensive penumbra.

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CT PERFUSION Iodine Injection CT angiography (CTA) and Perfusion CT (PCT) likewise give data in regards to vessel patency and the hemodynamic repercussions of a conceivable vessel impediment More broadly accessible Lower cost

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The Future More viable determination of patient for thrombolytic treatment PWI/DWI confuse as opposed to time of onset as sole determinant of choice MR porousness imaging: in light of element difference upgraded imaging Allows quantization of deformities in the blood-mind boundary, who have expanded danger of hemorrhagic change with thrombolytic treatment

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Conclusion Current imaging systems can be utilized to recognize hyperacutre stroke and guide treatment PWI/DWI crisscross would be a decent instrument to distinguish an objective gathering who might profit by early reperfusion Both CT and MR imaging are valuable for the thorough assessment of intense stroke

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Questions? Much obliged to you

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