Stroke

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Author: Dr Ayush Goel

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Stroke (cerebrovascular accident) is a neurological deficit that can occur due to:

• ischemia (ischaemic stroke)
• haemorrhage (haemorrhagic stroke)
• lobar haemorrhage
• hypertensive haemorrhage

Imaging

CT scan

First investigation to be undertaken is CT scan, to rule out haemorrhage. It is thus the investigation of choice for haemorrhagic stroke.

Axial Non contrast CT image showing left capsuloganglionic haemorrhage as hyperdense area
Image courtesy: Dr Ayush Goel

Hyperacute/early Ischaemic stroke is best evaluated on MRI (see below), however, there are subtle signs that may be present on CT to help make a diagnosis:

• Hyperdense MCA sign: shows clot in MCA (earliest sign on CT)
• Loss if Insular ribbon
• Loss of grey-white matter differenciation

Red - loss of insular ribbon and grey-white matter differentiation; green - normal insular ribbon, blue - normal deep grey matter.
Image courtesy: Dr Ayush Goel

Later, even CT can demonstrate the infarcted area very well as wedge shaped hypodensity in the particular vascular territory.

Chronic infarct in left MCA terriotory
Image courtesy: Dr Ayush Goel

MRI

It is the investigation of choice for ischaemic stroke.

Diffusion weighted MR imaging is the earliest to detect ischaemic region as hyperintense on DWI and hypointense on ADC maps.

ADC (Red circle) and DWI (Blue circle)
Image courtesy: Dr Garima Goel

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MedicoNotebook - Founder : DrShiviMudgal (Goel) , Co-Founder : DrAyushGoel