Different Perfusion Patterns in a Patient with Acute Ischemic Stroke

Rudilosso, Salvatore; Laredo, Carlos; Urra, Xabier; Chamorro, Ángel

doi:10.1016/j.jstrokecerebrovasdis.2017.02.025

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…Hypoperfusion on CTP maps was confirmed to be the most frequent finding in patients with RSSIs, but perfusion could also appear normal or even increased. Hyperperfusion is a phenomenon that may occur in large vessel stroke after recanalization, 23 but was anecdotally described in small cortical strokes 24 and in lacunar infarcts. 17 The presence of an established brain infarction on NCCT at the time of CTP acquisition was paradoxically less frequent in patients with hypoperfusion on CTP maps compared to those with normo-hyperperfusion.…”

Section: Discussionmentioning

confidence: 99%

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Rudilosso

Laredo

Mancosu³

et al. 2018

J Cereb Blood Flow Metab

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Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities. On dynamic sequential imaging analysis obtained from the source perfusion images, 32 patients (48%) had a sustained hypoperfusion pattern, 11 patients (16%) had a reperfusion pattern, and 18 patients (27%) had a delayed compensation pattern. Systolic blood pressure was higher in patients with sustained hypoperfusion although the perfusion pattern was independent of the final volume of infarction. These results reinforce the notion that mechanisms other than hypoperfusion are at play in patients with small subcortical infarcts including the intervention of compensatory sources of blood flow. The ultimate clinical significance of these perfusion patterns remains to be determined in larger series of patients assessed longitudinally.

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Section: Discussionmentioning

confidence: 99%

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Rudilosso

Laredo

Mancosu³

et al. 2018

J Cereb Blood Flow Metab

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Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Rudilosso

Rodríguez

Amaro

et al. 2020

Stroke

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Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

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Different Perfusion Patterns in a Patient with Acute Ischemic Stroke

Cited by 2 publications

References 4 publications

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Cerebral perfusion and compensatory blood supply in patients with recent small subcortical infarcts

Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

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