Neuroimaging in acute stroke

Jason W Tarpley MD PhD (

Dr. Tarpley of Pacific Neuroscience Institute Providence Southern California received consulting fees from Medtronic.

George P Teitelbaum MD (

Dr. Teitelbaum of Pacific Neuroscience Institute Providence Southern California received consulting fees from Medtronic.

David S Liebeskind MD (

Dr. Liebeskind of the University of California, Los Angeles, received consultation fees from Stryker and Medtronic.

Steven R Levine MD, editor. (

Dr. Levine of the SUNY Health Science Center at Brooklyn has no relevant financial relationships to disclose.

Originally released November 4, 2013; last updated January 6, 2020; expires January 6, 2023

This article includes discussion of neuroimaging in acute stroke, neuroimaging in stroke, acute stroke neuroimaging, acute stroke brain imaging, acute ischemic stroke imaging, imaging guided thrombolysis for acute ischemic stroke, and imaging guided thrombectomy for acute ischemic stroke. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.


Rapid diagnosis of acute ischemic stroke has become exceedingly important given modern stroke therapies and is highly dependent on neuroimaging findings. 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 update on the use of neuroimaging in the diagnosis and management of the acute ischemic stroke patient.

Key points


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


• Consistency of the imaging strategy within a given institution is critical 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 powerful and effective reperfusion therapies including intravenous thrombolysis and endovascular thrombectomy. The indications for these therapies have expanded thanks to high quality research.


• A second but fundamental goal of stroke imaging is to inform the diagnostic workup for stroke mechanism, treatment, and secondary prevention. Adequate expertise in vascular neurology with understanding of cerebrovascular anatomy and pathology and their manifestation on imaging should form the basis of this workup.


• Advancements in expediting stroke imaging workflow including artificial intelligence, the “direct to angiography” pathway, and prehospital imaging are under investigation now and have the capacity to advance the field of stroke intervention.

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