Skip to Main Content

++

An 84-year-old female slumped over in her chair at a senior citizen center. She was unable to move her right side.

++

She arrived in the ED twenty minutes after the stroke onset. She had a “dense” right hemiparesis with no motor strength of her arm and face. Her speech was slurred but fluent and she had normal language comprehension.

++

The “stroke team” was notified and a “stroke CT” was performed shortly after her arrival: noncontrast CT (Figure 1), perfusion CT (Figure 2), and CT angiogram.

++
++
Figure 2
Graphic Jump Location

Perfusion CT (same level as CT slice in upper right corner of Figure 1).

(A) Time-to-peak. (B) Cerebral blood volume

++

Recombinant tissue plasminogen activator (rt-PA) was administered within 30 minutes of her arrival in the ED.

+

  • What does the noncontrast CT show?
  • What does the perfusion CT suggest about the potential benefit of thrombolytic therapy?

++ ++

Several new CT and MR imaging modalities have been developed that could potentially improve acute stroke management (Table 1). The role of these tests include: (1) accurate early identification of an acute ischemic stroke; (2) distinguishing potentially salvageable ischemic brain tissue from irreversible ischemia (the ischemic penumbra); and (3) visualization of the vascular lesion responsible for the ischemic event. The benefits of these imaging modalities have yet to be proven in large clinical trials and their use remains experimental.

++
Table Graphic Jump Location
Table 1 Advanced Imaging in Ischemic Stroke
++

Early diagnosis of stroke can be made using diffusion-weighted MRI, perfusion CT and CT angiographic source images. Distinguishing potentially salvageable from irreversibly ischemic brain tissue can be accomplished using perfusion CT or perfusion-weighted MRI (Figure 2). Vascular lesions are demonstrated using CT angiography or MR angiography.

++...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.