Book MRI in Ischemic Stroke by Rüdiger von Kummer, Tobias Back, K. Sartor

By Rüdiger von Kummer, Tobias Back, K. Sartor

The imaging of stroke has gone through major adjustments as a result of the swift growth in imaging know-how. This quantity, comprising 3 components, is designed to supply a finished precis of the present function of MR imaging in sufferers with ischemic stroke. the 1st half outlines the scientific shows of stroke and discusses the diagnostic efficacy and healing impression of MR imaging. the second one and 3rd components shape the middle of the quantity, and are in accordance with a singular strategy in that the subject is gifted from very diversified viewpoints. half 2 offers an in depth presentation of the distinguishing good points of stroke from the radiologist's viewpoint. in contrast, half three addresses the desires of the clinician, documenting particular stroke syndromes and their correlates on MR imaging. the final target has been to create a well-illustrated quantity with large charm that hyperlinks pathology, radiology and stroke medication in an informative manner.

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Extra resources for Book MRI in Ischemic Stroke

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Consequently, there was major infarct expansion. b Patient treated with t-PA 5 h after symptom onset following MRI. Pre-therapy there is an occluded proximal M1 segment. Following tPA there is recanalization and reperfusion. In contrast to (a), there is salvage of a large amount of acute perfusion-diffusion mismatch tissue from infarction. Of interest, there is minor reduction in the DWI lesion after thrombolysis A phase II study of a new thrombolytic agent, desmoteplase, has also recently been completed (Hacke 2004).

These results suggest that a trial of acute, aggressive glycaemic control in stroke might be optimised by using PI/DWI to select patients with salvageable at-risk tissue (Baird et al. 2003; Parsons et al. 2002b). In a similar vein, decompressive hemicraniectomy has been shown to reduce mortality after malignant MCA infarction (Schwab et al. 1998). It appears the earlier the surgery is performed, the better the outcome. MRI is promising in predicting the likelihood of this complication within 6 h of stroke onset (Thomalla et al.

1998a). Thus, there is substantial evidence to indicate that perfusion-diffusion mismatch tissue is ‘at risk’ of progressing to infarction if rapid reperfusion does not occur (Baird et al. 1997; Barber et al. 1998a; Beaulieu et al. 1999; Schlaug et al. 1999; Warach et al. 1996). These observations provide compelling support for the mismatch model of the ischaemic penumbra as the natural history of early DWI lesions in untreated patients is to grow over time into the area of the initial PI lesion as the penumbra progressively fails and becomes recruited into the infarct (Fig.

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