<scp>CT</scp> perfusion in acute stroke calls: A pictorial review and differential diagnoses

Chiu, Albert; Phillips, Timothy J; Phatouros, Constantine C.; Singh, Tejinder; Hankey, Graeme J.; Blacker, David; McAuliffe, William

doi:10.1111/1754-9485.12422

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…EVT is offered as adjunctive treatment to alteplase if the CT angiographic image identifies a LVO in the anterior circulation, and if the CT perfusion scan identifies a salvageable penumbra (increased time to peak) surrounding any core infarction (decreased cerebral blood volume) [5]. Patients proceed to EVT while the alteplase infusion is in progress.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

Wee

McAuliffe

Phatouros

et al. 2017

Cerebrovasc Dis Extra

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Background and Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. Methods: We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0–1, or a decrease from baseline of ≤8, at 24 h after stroke onset. Results: Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.

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Section: Methodsmentioning

confidence: 99%

Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

Wee

McAuliffe

Phatouros

et al. 2017

Cerebrovasc Dis Extra

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“…Owing to the major technological advances in neuroimaging, the diagnostic accuracy and prognosis of stroke have improved dramatically in the past few decades. However, imaging studies are limited by low sensitive to infarction in the first 2 hrs and unavailability in limited-resource areas 11. Thus, innovative diagnostic tools and biomarkers have been proposed including acute phase reactants, IL-6, and microRNAs (miRNA) 12…”

Section: Introductionmentioning

confidence: 99%

<p>The expression of microRNA 146a in patients with ischemic stroke: an observational study</p>

Kotb¹,

Ibrahim²,

Mohamed³

et al. 2019

IJGM

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Aim We conducted the present prospective study to assess the level of microRNA (miRNA) 146a in patients with ischemic stroke and its correlation with patients’ characteristics. Methods We conducted an observational study that included adult patients (≥18 years old) who presented within 24 hrs after the onset of the symptoms of acute ischemic stroke. In addition, age- and sex-matched healthy volunteers were included as control group. The primary outcome in the present study was the difference in miRNA 146a expression between patients with ischemic stroke and control group participants. The expression of miRNA 146a was measured using quantitative real-time PCR. Quantitative real-time PCR amplification and analysis were performed using Rotor-Gene Q thermal cycler. Results The present study included 44 patients with ischemic stroke and 22 matched controls. Regarding the primary outcome of the present study, the median expression of miRNA 146a in patients with ischemic stroke was −1.98 fold (IQR −27.1–3.9) compared to 1.75 fold (IQR −2.25–5.27) in control group ( P <0.001). However, the subgroup analysis showed that the expression of miRNA 146a was significantly downregulated in comatosed patients only ( P <0.001). The expression of miRNA 146a correlated negatively with Glasgow Coma Scale score in comatose patients ( r =−0.352, P =0.022). Conclusion In conclusion, the expression of miRNA 146a is significantly downregulated in ischemic stroke patients. Further studies are needed to assess its diagnostic utility and therapeutic potentials.

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“…The parieto-occipital lobes seem to be more likely involved in PRES, although involvement of other regions of the brain is possible. [60][61][62][63] Perfusion imaging alterations in patients diagnosed with PRES are inconsistent among studies. While some studies found a hypoperfusion pattern characterized by decreased CBF and CBV and delayed MTT and Tmax, 62,64 others showed hyperperfusion with increased CBF and CBV and decreased MTT and Tmax in patients with PRES (Figure 4).…”

Section: Posterior Reversible Encephalopathy Syndromementioning

confidence: 99%

Clinical application of brain perfusion imaging in detecting stroke mimics: A review

Khalili

Wang

Garg

et al. 2022

Journal of Neuroimaging

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Stroke mimics constitute a significant proportion of patients with suspected acute ischemic stroke. These conditions may resemble acute ischemic stroke and demonstrate abnormalities on perfusion imaging sequences. The most common stroke mimics include seizure/epilepsy, migraine with aura, brain tumors, functional disorders, infectious encephalopathies, Wernicke's encephalopathy, and metabolic abnormalities. Brain perfusion imaging techniques, particularly computed tomography perfusion and magnetic resonance perfusion, are being widely used in routine clinical practice for treatment selection in patients presenting with large vessel occlusion. At the same time, the utilization of these imaging modalities enables the opportunity to better diagnose patients with stroke mimics in a time‐sensitive setting, leading to appropriate management, decision‐making, and resource allocation. In this review, we describe patterns of perfusion abnormalities that could discriminate patients with stroke mimics from those with acute ischemic stroke and provide specific case examples to illustrate these perfusion abnormalities. In addition, we discuss the challenges associated with interpretation of perfusion images in stroke‐related pathologies. In general, perfusion imaging can provide additional information in some cases—when used in combination with conventional magnetic resonance imaging and computed tomography—and might help in detecting stroke mimics among patients who present with acute onset focal neurological symptoms.

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CT perfusion in acute stroke calls: A pictorial review and differential diagnoses

Cited by 10 publications

References 22 publications

Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

<p>The expression of microRNA 146a in patients with ischemic stroke: an observational study</p>

Clinical application of brain perfusion imaging in detecting stroke mimics: A review

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