Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewAdvanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment.
Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. The authors review advanced noninvasive brain imaging by CT and MR imaging for the evaluation of AIS focusing on penumbral and collateral imaging.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewComputed Tomography, Computed Tomography Angiography, and Perfusion Computed Tomography Evaluation of Acute Ischemic Stroke.
This review outlines the current role of the individual components of multimodal computed tomography (computed tomography, computed tomography angiography, and perfusion computed tomography) in the evaluation of patients with acute ischemic stroke.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewReperfusion Changes After Stroke and Practical Approaches for Neuroprotection.
Reperfusion is the first line of care in a growing number of eligible acute ischemic stroke patients. Early reperfusion with thrombolytic drugs and endovascular mechanical devices is associated with improved outcome and lower mortality rates compared with natural history. ⋯ In this article, the functional and structural changes and underlying molecular mechanisms of ischemia and reperfusion are reviewed. The pathways that lead to reperfusion injury and novel neuroprotective strategies with endogenous properties are discussed.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewOligemia, Penumbra, Infarction: Understanding Hypoperfusion with Neuroimaging.
Despite recent progress in the treatment of acute ischemic stroke with multiple trials demonstrating improved clinical outcome associated with endovascular thrombectomy up to 24 hours after onset, there is potential opportunity for optimal patient selection and treatment algorithm to further improve treatment outcome. Current limitation is in part caused by inconsistency of imaging protocols and imaging-based definitions of oligemia, penumbra, and infarction core within the various hypoperfusion states. To truly maximize the impact of imaging in acute ischemic stroke, imaging definitions of hypoperfusion states need to be more consistent and validated to correctly reflect different severities of ischemic injury.
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The most feared complication after acute ischemic stroke is symptomatic or asymptomatic hemorrhagic conversion. Neuroimaging and clinical criteria are used to predict development of hemorrhage. ⋯ Malignant infarction develops when cytotoxic edema is large enough to lead to herniation and death. Post-stroke neuroimaging prognosticators have been described and should be assessed early so that appropriate treatment is offered before herniation leads to additional tissue injury.