Acute stroke imaging and intervention Flashcards
How can penumbra be distinguished from dead tissue?
MRI or CT perfusion.
Can also use a combination of CT, perfusion CT, and CT angiography.
What happens when you administer tPA into dead brain tissue?
What are other contraindications to tPA administration are visible on CT?
Hemorrhagic infarct.
Neoplasm, hemorrhage, hematoma, large apparent infarct.
On a perfusion CT, what differentiates brain at risk from dead tissue?
Both will show delayed “time to start” (mean transit time) and “increased time to peak”
Dead tissue will show “decreased blood volume”
Penumbra will show “normal or increased blood volume”
What MRI modality can distinguish a new hemorrhage from an old one?
Diffusion Weighted Imaging (DWI)
39 y/o RH female Presented to UH ED 0.5 hrs after onset of left sided weakness, facial droop and neglect.
Noncontrast CT unremarkable.
CT perfusion scan shows increased time to peak in the right cerebral hemisphere, and increased total blood volume also in the right hemisphere. What is the diagnosis? What is the treatment?
Ischemic (embolic) stroke in the right MCA. Administer tPA immediately, followed by surgical intervention (penumbra aspiration).
