Neuroimaging in stroke

Jason W Tarpley MD PhD (Dr. Tarpley of the University of California, Los Angeles, has no relevant financial relationships to disclose.)
Amit Balgude MD (Dr. Balgude of Lakewood Regional Medical Center has no relevant financial relationships to disclose.)
David S Liebeskind MD (Dr. Liebeskind of the University of California in Los Angeles received consulting fees from Stryker and Medtronic.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released November 4, 2013; last updated February 1, 2016; expires February 1, 2019

Overview

The diagnosis of acute ischemic stroke and conditions that mimic its clinical presentation has become increasingly dependent on neuroimaging findings. Additionally, neuroimaging directly guides treatment of acute stroke patients by identifying appropriate candidates for acute therapies and informing the workup of stroke etiology. The authors provide an article on the use of neuroimaging in the diagnosis and management of the acute ischemic stroke patient.

Key points

 

• When performing neuroimaging evaluation of stroke and transient ischemic attack patients, there are several appropriate imaging strategies.

 

• Consistency of the imaging strategy within a given institution is important to facilitate reliable technical execution, rapid evaluation, and accurate interpretation of results.

 

• The primary goal of acute imaging in ischemic stroke is to identify candidates for treatments including intravenous thrombolysis and endovascular revascularization.

 

• A second but fundamental goal of stroke imaging is to establish stroke etiology that may direct management such as anticoagulation for atrial fibrillation, appropriate management of arterial dissection, intervention for symptomatic carotid artery stenosis, and medical management as first line of intracranial stenosis.

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