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  • Updated 07.21.2021
  • Released 11.04.2013
  • Expires For CME 07.21.2024

Neuroimaging in acute stroke

Introduction

Overview

Rapid diagnosis of acute ischemic stroke has become exceedingly important given the changing landscape of modern stroke therapies and is critically dependent on neuroimaging identification of stroke pathology. Neuroimaging directly guides treatment of acute stroke patients by identifying appropriate candidates for acute therapies and informing the workup of stroke etiology. In the last few years, our intravenous and endovascular treatments for acute stroke have advanced dramatically, and imaging has advanced concurrently. 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 in the emergent setting, 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 endovascular thrombectomy and intravenous thrombolysis. The indications for these therapies have expanded thanks to high quality research.

Medium vessel occlusion treatment with endovascular and thrombolytic therapies represents a new frontier in acute stroke treatment. As acute stroke treatment evolves, acute stroke imaging must evolve in parallel to identify these medium vessel occlusions.

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.

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