Clinical Implications of Neuroimaging in Stroke

• Published in: Translational stroke research 2012-06, Vol.3 (2), p.178-181
• Main Authors: Olaya, Joffre E., Keen, Joseph R., Hsu, Frank P. K.
• Format: Article
• Language: English
• Subjects: Biomedical and Life Sciences; Biomedicine; Blood; Cardiology; Commentaries; Edema; Hematoma; Hemorrhage; Ischemia; Medical imaging; Mortality; Neuroimaging; Neurology; Neurosciences; Neurosurgery; Patients; Stroke; Surgery; Vascular Surgery
• ISSN: 1868-4483; 1868-601X
• DOI: 10.1007/s12975-012-0170-0

Early CT hypodensity involving more than 50 % of the middle cerebral artery (MCA) territory has been shown to be a predictor of fatal brain edema formation [4]. [...]it is critical to rapidly and accurately determine whether a patient has an ischemic stroke as these patients may benefit from different treatment paradigms if detected and treated early enough. Decompressive surgery reduces mortality and increases the number of patients with a favorable functional outcome when treated within 48 h after ischemic stroke onset in patients between 18 and 60 years of age as demonstrated in the DECIMAL [5], DESTINY [6], and HAMLET [7] trials [8]. Tissue plasminogen activator (tPA) is the only FDA-approved thrombolytic agent for the treatment of acute stroke [10]. tPA can be used to treat an ischemic stroke by promoting clot lysis and thereby helping restore blood flow to the affected brain tissue. Because of the inclusion and exclusion criteria, only about 2 % of patients with ischemic strokes in the USA actually receive tPA [11]. tPA should be administered as soon as possible after the onset of symptoms as it has been shown to improve clinical outcome if given within 3 h [12]. A “spot sign” scoring system has been developed and has been shown to be an independent predictor of in-hospital mortality and poor outcome in survivors with primary intracerebral hemorrhage [21].