Diagnosis of Ischemic Stroke: As Simple as Possible

Abstract

The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.

Early and late infarct growth rate in ischemic stroke patients after successful endovascular treatment in early time window: correlation of imaging and clinical factors with clinical outcome

“…Despite massive scientific effort in the diagnosis of acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation and its treatment, time factors and size of the ischemic core remain the main factors that influence clinical outcome ( 1 ). In 2006, Saver quantified the number of neurons, synapses, and myelinated fibers lost as a function of time in AIS, and concluded that each minute of AIS leads to the loss of 1.9 million neurons, 14 billion synapses, and 12 km of myelinated fibers ( 2 ).…”

CT Brain Perfusion in the Prediction of Final Infarct Volume: A Prospective Study of Different Software Settings for Acute Ischemic Core Calculation

“…In addition to non-enhanced CT (NECT) and CT angiography (CTA), CT perfusion (CTP) has become an inseparable part of ischemic “code-stroke” protocols in some centers. It is believed that CTP is able to distinguish non-salvageable, irreversible ischemic brain tissue (core) from salvageable, reversible ischemia (penumbra) [ 5 , 6 ]. Moreover, CTP results are included in the EVT guidelines in patients with AIS with LVO in the anterior circulation presenting beyond the 6 h time window from onset and in patients with unknown time of last known well (LKW) [ 1 , 3 ].…”