Imaging in Stroke

Question 1

CT brain changes Ischaemic stroke

Answer 1

Exclude hemorrhage
no abnormalities 1st few hours
Features of infarction
- parenchymal hypodensity
- loss of grey/white matter differentiation\
-effacement of cortical sulci
-local mass effect
-loss of insular ribbon
-obscuration of lentiform nucleus
- hyperdense middle or other cerebral art
- attenuation:
   - initially increased, then isodense, then reduced attenuation

Question 2

CT Brain features associated with poor outcome from tPA

Answer 2

• cortical hypodensity > 1/3 MCA territory
• sulcal effacement
• mass effect
• cerebral edema

Question 3

CT brain changes in hemorrhagic stroke

Answer 3

• 1st week
• high attenuation mass
• hypodense area maybe active bleeding
  > 1st week
• decreasing density & blurring of margins from periphery
• adjacent edema in subacute phase
• may have lucent halo with rim of contrast enhancement mimicking tumour/ infection
• looses mass effect
  > 3 weeks
• isodense
  >10 weeks
• hypoattenuation

Question 4

CT location of ICH & DDx

Answer 4

Central
* basal ganglia
* primary intracerebral
Peripher
* primary tumour
* melanoma
* choriocarcinoma
* thyroid
* testicular
*oat cell
* AVM
* aneurysm
* mycotic
* congenital