Current concepts in imaging and endovascular treatment of acute ischemic stroke: implications for the clinician

Chalumeau²,

et al. 2020

Stroke

Background and Purpose: Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. Methods: We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. Results: Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger ( P =0.032) and had a history of diabetes mellitus more frequently ( P =0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging ( P =0.18 and P =0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P =0.016), higher rate of multivessel occlusion (50% versus 8.8%, P =0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores; median: 5 versus 8, P =0.006), and higher infarct core volume (median: 58 versus 6 mL, P =0.004). Successful recanalization rate was similar in both groups ( P =0.767). In-hospital mortality was higher in the COVID-19 patients’ group (41.7% versus 11.8%, P =0.025). Conclusions: Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.

Section: Discussionmentioning

confidence: 99%

Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients

Chalumeau²,

et al. 2020

Stroke

“…13,14 Computed tomography angiography is primarily used to assess for the presence of a large-vessel occlusion (LVO) and obtain a vascular roadmap for EVT procedure planning. 15,16 The location and length of thrombus should be recorded 17 with thrombus length >8 mm less likely to resolve with IV tissue plasminogen activator alone. 18 Tips M1 occlusion will typically result in basal ganglia infarction.…”

Section: Computed Tomography Angiogrammentioning

confidence: 99%

“…28 Tandem lesions are defined by occlusive or subocclusive ''double'' filling defects in the cervical ICA and distally within the intracranial arterial circulation. 15 The most common causes for cervical lesions include atherosclerotic plaque and carotid dissection (more frequent in younger patients 29 ); see Figure 4.…”

Section: Tandem Lesionsmentioning

confidence: 99%

CT Imaging of Acute Ischemic Stroke

et al. 2020

Although acute ischemic stroke remains one of the most common causes of death and disability worldwide, it is a potentially treatable condition if appropriately managed in a timely manner. The goals of acute stroke imaging include establishing a diagnosis as fast as possible with (1) accurate infarct quantification, (2) intracranial and cervical vasculature assessment, and (3) brain perfusion analysis for detection of infarct core and potentially salvageable penumbra allowing optimal patient selection for appropriate therapy. Given the extensive number of images generated from acute stroke imaging studies and as “time is brain,” this article aims to highlight a logical approach for the radiologist in acute stroke computed tomography imaging in order to accurately interpret and communicate results in a timely manner.

“…CT angiography (CTA) or MR angiography (MRA) using time of flight (TOF) is useful to identify vascular occlusion or stenosis. Perfusion CT and MR are also useful to show penumbra, this reversible ischemia after reperfusion [13].…”

Section: Ischemic Strokementioning

confidence: 99%

Imaging Evaluation of Patients with Cranial Nerve Disorders

Krainik

2020

IDKD Springer Series

ADC Apparent diffusion coefficient CN Cranial nerves CNS Central nervous system CT Computed tomography CTA Computed tomography angiography DWI Diffusion weighted images FS Fat-saturated MRA Magnetic resonance angiography MRI Magnetic resonance imaging MS Multiple sclerosis NF Neurofibromatosis NMOsd Neuromyelitis optica spectrum disorders NVC Neurovascular conflict SWI Susceptibility weighted images TOF Time of flight TZ Transition zone WI Weighted images Learning Objectives • To know the imaging appearance of the most frequent cranial nerve lesions and be aware of associated CN disorders • To understand that different lesions can be found on the different anatomical segments of the cranial nerves (intraaxial, extraaxial intracranial, extracranial) and that dedicated imaging techniques are needed to investigate these different segments and various pathologies Key Points • Intraaxial lesions usually cause multiple CN disorders in association with CNS dysfunctions • Extraaxial intracranial lesions may cause unique or multiple CN disorders with meningeal syndrome and intracranial hypertension • Skull base lesions usually cause unilateral unique or multiple CN disorders. • Extracranial lesions may cause unilateral unique or multiple CN disorders with craniocervical objective lesions. • Painful CN disorder may reveal aneurysm and dissection Key Points • Be aware of clinical history, presentation, and biological tests for imaging interpretation • Master CN anatomy including nucleus, apparent origin, route, and target • MRI is the modality of choice to investigate CN disorder • CT is useful to depict calcification and skull lesion • Add MRA and CTA when painful CN disorder