The radiology of an ischaemic stroke

Ischaemic Stroke

Jessica Peter Roscoe

Contents...

➢Brief introduction

➢Case study

➢ Imaging

➢Radiological signs

➢Treatment options

Introduction

➢Focal neurological deficit

➢ Ischaemic V. Haemorrhagic

➢Modifiable risk factors

➢Symptoms depend on the area of the

brain affected

Case Study

❏ 79yo female

❏ Left sided weakness

❏ Post trauma

❏ Past history MCA territory stroke

❏Rule out: haemorrhagic stroke, ischaemic

stroke, traumatic haemorrhage

❏ 2x CTs performed

Stroke Imaging

➢What imaging is appropriate?

➢How does the imaging contribute to the

diagnosis?

➢How does the imaging contribute to the

management?

Radiological signs

➢ Earliest

○ Hyperdense segment

of a vessel

○ Visible thrombus/

embolus

Case courtesy of Dr Frank Gaillard, Radiopaedia.org

Radiological signs

➢Hyperacute○ Loss of grey-white matter differentiation

○ Cortical hypodensity

○ Dependent upon the occlusion location and

whether collaterals are present

Radiological signs

➢Week one○ Marked hypo-attenuation and swelling

Radiological signs

➢Week two/three○ CT fogging - decrease in swelling and

increased attenuation of the cortex

○ Confusing to interpret, can lead to a missed

diagnosis

CT fogging - previous infarct is isodense and

difficult to identify

Radiological signs

➢Months later○ Swelling continues to reduce

○ Region of low density

Treating an ischaemic stroke

➢Rapidly restore cerebral blood flow○ Thrombolysis

○ Thrombectomy

➢Rehabilitation

Thank You!

Any Questions?