Practical Neuroimaging in Stroke: A Case-Based Approach

Description

Practical Neuroimaging in Stroke, by Alejandro Rabinstein, MD, and Steven J. Resnick, is a neurology reference designed for anyone involved in treating stroke patients. It offers unique, thorough guidance-driven by nearly 500 completely original high-quality images from actual stroke cases-to help you learn and understand the clinical value of diagnostic neuroimaging. Examples of different diagnostic modalities-accompanied by succinct teaching messages-highlight a preference for those most commonly used in clinical practice and most typically interpreted by clinicians caring for patients at bedside. A consistent section format from chapter to chapter enables you to easily access the material. Brilliantly illustrated and clinical relevant, Practical Neuroimaging in Stroke is the closest thing to treating real-life patients! A Case-Based Approach Hypoxic-Ischemic Brain Damage ADDITIONAL EXAMPLES OF GLOBAL BRAIN EDEMA Cortical Laminar Necrosis Basal Ganglia Involvement W atershed Infarctions Vulnerable Cortical Areas: Perirolandic and Occipital Cortex False Radiological Signs: Pseudo-Subarachnoid Hemorrhage and False Middle Cer Early and Delayed White Matter Changes: Anoxic Leukoencephalopathy Clinical-Anatomical Syndromes of Ischemic Infarction Alejandro A. Rabinstein and Steven J. Resnick CAROTID BIFURCATION OCCLUSION MIDDLE CEREBRAL ARTERY OCCLUSION T erritorial MCA Infarction Deep Middle Cerebral Artery Infarction Superfi cial Divisional Middle Cerebral Artery Infarction Superfi cial Cortical Infarctions T ABLE 2-1. Clinical features of MCA branch infarctions. Brain region Arterial branches Distinctive features Additional signs Hemispheric Border-Zone Infarctions ANTERIOR CEREBRAL ARTERY OCCLUSION ANTERIOR CHOROIDAL ARTERY OCCLUSION POSTERIOR CEREBRAL ARTERY OCCLUSION T ABLE 2-2. Visual fi eld disturbance caused by PCA infarction. VERTEBROBASILAR DISEASE T ABLE 2-3. Signs suspicious for basilar artery occlusion. CEREBELLAR INFARCTIONS P osterior Inferior Cerebellar Artery Infarction Case Vignette Anterior Inferior Cerebellar Artery Infarction Superior Cerebellar Artery Infarction Cerebellar Border-Zone Infarctions BRAINSTEM INFARCTIONS Medullary Infarctions Case Vignette W allenberg’s Syndrome P ontine Infarctions Midbrain Infarctions Case Vignette References Acute Stroke Imaging T ABLE 3-1. Indications and purposes of emergency neuroimaging in patients wi Indication/purpose Imaging modality COMPUTED TOMOGRAPHY CT Signs of Acute Ischemia Case Vignette T ABLE 3-2. Early signs of ischemic stroke on brain CT scan. Sign Signifi cance CT Perfusion T ABLE 3-3. Relative advantages of CT perfusion and DWI-PWI MRI for the asse CT Angiogram MAGNETIC RESONANCE IMAGING Diffusion-Weighted and Perfusion-Weighted Imaging T ABLE 3-4. Main practical uses of DWI in patients with acute stroke presenta PWI-DWI Mismatch Direct Thrombus Visualization MAGNETIC RESONANCE ANGIOGRAPHY IMAGING IN STROKE EMERGENCIES Intravenous Thrombolysis Case Vignette Intra-Arterial Revascularization Therapies Massive Hemispheric Infarction Acute Internal Carotid Artery Occlusion Case Vignette Basilar Artery Occlusion Case Vignette Massive Cerebellar Infarction Subacute and Chronic Infarctions Cardiac Embolism T ABLE 4-1. Cardiac sources of embolism. T ABLE 4-2. Radiological characteristics of cardioembolic strokes. Defi nite Probable P ossible A TRIAL FIBRILLATION Case Vignette DILATED CARDIOMYOPATHY MYOCARDIAL INFARCTION PROSTHETIC VALVES NONBACTERIAL THROMBOTIC ENDOCARDITIS MITRAL STENOSIS AND ANNULAR CALCIFICATION A TRIAL MYXOMA P A TENT FORAMEN OVALE Case Vignette PROXIMAL AORTIC ATHEROSCLEROTIC PLAQUE Case Vignette References Extracranial Large Artery Atherothrombosis Sebastian Koch ULTRASONOGRAPHY MR AND CT ANGIOGRAPHY CATHETER CEREBRAL ANGIOGRAPHY Case Vignette CLINICAL FEATURES OF CAROTID ATHEROTHROMBOSIS Case Vignette MECHANISMS OF INFARCTION Atherothrombotic Embolism Case Vignette Hemodynamic Infarction TREATMENT Symptomatic Carotid Disease Asymptomatic Carotid Artery Stenosis Carotid Revascularization Case Vignette VERTEBRAL ARTERY ATHEROSCLEROSIS Case Vignette Intracranial Atherosclerotic Disease Jose G. Romano EPIDEMIOLOGY AND NATURAL HISTORY MECHANISMS OF CEREBRAL ISCHEMIA T ABLE 6-1. T CD and MRA cutoff parameters to detect 50% stenosis of larg DIAGNOSIS OF INTRACRANIAL A THEROSCLEROTIC DISEASE T CD (mean fl ow velocity) MRA MEDICAL THERAPY T ABLE 6-2. Probability of stroke recurrence at 2 years in the territory of Risk of recurrence INTERVENTIONAL APPROACHES Small Vessel Disease SMALL SUBCORTICAL INFARCTIONS LACUNAR SYNDROMES STRIATOCAPSULAR INFARCTIONS CAPSULAR WARNING SYNDROME MULTIPLE LACUNAR INFARCTIONS SILENT INFARCTIONS, WHITE MATTER DISEASE, AND DEMENTIA References Uncommon Causes of Stroke CERVICOCRANIAL ARTERIAL DISSECTIONS Case Vignette T ABLE 8-1. Angiographic signs of cervical artery dissections. A ORTIC DISSECTIONS FIBROMUSCULAR DYSPLASIA DOLICHOECTASIA MOYAMOYA CADASIL MELAS REVERSIBLE CEREBRAL VASOCONSTRICTION HYPERCOAGULABILITY T ABLE 8-2. Differential diagnosis of cerebral vasculitis. V ASCULITIS Primary Central Nervous System Angiitis Case Vignette Giant Cell (Temporal) Arteritis SUSAC’S Syndrome Infectious Vasculitis HIV VASCULOPATHY STROKES FROM SUBSTANCE ABUSE SICKLE CELL DISEASE Spinal Cord Infarction V ASCULAR ANATOMY OF THE SPINAL CORD MANAGEMENT AND PROGNOSIS References Spontaneous Intraparenchymal Hemorrhage STRIATOCAPSULAR HEMORRHAGES T ABLE 10-1. Anatomical classifi cation of striatocapsular hemorrhages. T ype Site of bleeding Arterial territory Lateral Putaminal Hemorrhage Massive Striatocapsular Hemorrhage P osterolateral Striatocapsular Hemorrhage Middle-Posteromedial Striatocapsular Hemorrhage Caudate Hemorrhage Hematoma Expansion T ABLE 10-2. Causes of lobar intracerebral hemorrhage other than primary art Cause Diagnosis Case Vignette Hydrocephalus T emporal Hematomas Focal Lobar Hemorrhage Surgical Evacuation (Figure 10-12) THALAMIC HEMORRHAGES T ABLE 10-3. Anatomical classifi cation of thalamic hemorrhages. T ype Arterial territory Global Thalamic Hematomas Anterior Thalamic Hemorrhage P osteromedial Thalamic Hemorrhage P osterolateral Thalamic Hemorrhage Dorsal Thalamic Hemorrhage PONTINE HEMORRHAGES T ABLE 10-4. T ypes of pontine hemorrhage. T ype Region involved Massive Pontine Hemorrhage Bilateral Tegmental Hemorrhage Unilateral Tegmental Hemorrhage ❖ Survival is the rule. 45,46,48 CEREBELLAR HEMORRHAGES Large Cerebellar Hematomas with Surgical Decompression Benign Hemispheric Cerebellar Hemorrhages V ermian Hemorrhages INTRAVENTRICULAR HEMORRHAGES References Secondary Intraparenchymal Hemorrhages CEREBRAL AMYLOID ANGIOPATHY T ABLE 11-1. Secondary causes of intraparenchymal hemorrhage Case Vignette HEMORRHAGIC TRANSFORMATION Case Vignette HEMORRHAGIC COMPLICATIONS OF THROMBOLYSIS Case Vignette ANTICOAGULATION-RELATED INTRACEREBRAL HEMORRHAGE COAGULOPATHY SUBSTANCE ABUSE V ASCULITIS CEREBRAL VENOUS THROMBOSIS Case Vignette ARTERIOVENOUS MALFORMATIONS CAVERNOUS MALFORMATION DURAL ARTERIOVENOUS FISTULA TUMOR TRAUMA Subarachnoid Hemorrhage Grade Fisher scale Modifi ed Fisher scale CAUSES OF EARLY DETERIORATION: REBLEEDING AND HYDROCEPHALUS GLOBAL CEREBRAL EDEMA CEREBRAL VASOSPASM V ASOSPASM: ENDOVASCULAR TREATMENT P A TTERNS OF ISCHEMIA SUBARACHNOID HEMORRHAGE WITH NEGATIVE ANGIOGRAM P erimesencepahlic Subarachnoid Hemorrhage Non-Perimesencephalic Subarachnoid Hemorrhage with Negative Angiogram CONDITIONS MIMICKING ANEURYSMAL SUBARACHNOID HEMORRHAGE Pseudo-Subarachnoid Hemorrhage T raumatic Subarachnoid Hemorrhage Causes of Sulcal Subarachnoid Hemorrhage V ascular Anomalies of the Brain Nils Mueller-Kronast INTRODUCTION TO ANGIOGRAPHIC MODALITIES Catheter Angiography Three-Dimensional Digital Subtraction Angiography Computed Tomography Angiography Magnetic Resonance Angiography COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING MRI ANEURYSMS General Concepts T ypes of Aneurysms TREATMENT T ABLE 13-1. Five-year cumulative rupture rates according to size and locatio 7 mm 7–12 mm 13–24 mm 25 mm Case Vignette ARTERIOVENOUS MALFORMATIONS General Concepts Natural History T reatment Options T ABLE 13-2. Spetzler-Martin arteriovenous malformation grading system. 89 Description P oints Case Vignette DURAL ARTERIOVENOUS FISTULAS General Concepts Cranial Dural Arteriovenous Fistulas Cavernous Dural Arteriovenous Fistulas T ABLE 13-3. Barrow classifi cation of carotid-cavernous sinus arteriovenous fi Extracavernous Dural Arteriovenous Fistulas T ABLE 13-4. Risk of intracranial hemorrhage based on venous drainage and Bor V enous outfl ow Borden type Presentation 105 Natural History 1 03,106 T reatment References Cerebral Venous Thrombosis Alexander Y. Zubkov, Steven J. Resnick, and Alejandro A. Rabinstein Case Vignette ANATOMY OF THE VENOUS SYSTEM Dural Sinuses Superfi cial Cerebral Veins Deep Cerebral Veins IMAGING CHARACTERISTICS OF CVT Computed Tomography Signs of Parenchymal Involvement Magnetic Resonance Imaging T ABLE 14-1. T emporal changes of signal intensity of intraluminal venous thr MRI Sequence Acute phase ( 1 wk) Subacute phase (1–2 wks) Late subacute and chronic phase ( 2 wks) Signs of Parenchymal Involvement Angiographic, Magnetic Resonance, and Computed Tomography Venograms MR Venography CT Venography Conventional Angiography SINUS OCCLUSION SYNDROMES Superior Sagittal Sinus T ransverse Sinus Thrombosis Cavernous Sinus Thrombosis Deep Vein Thrombosis Cortical Vein Thrombosis Atypical Presentations MANAGEMENT AND PROGNOSIS References