Skip to main content Accessibility help
×
Home
Hostname: page-component-684899dbb8-c97xr Total loading time: 0.66 Render date: 2022-05-28T14:57:37.930Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true }

Chapter 13 - Cerebrovascular disease

overview

from Section 2 - Cerebrovascular disease

Published online by Cambridge University Press:  05 March 2013

Jonathan H. Gillard
Affiliation:
University of Cambridge
Adam D. Waldman
Affiliation:
Imperial College London
Peter B. Barker
Affiliation:
The Johns Hopkins University School of Medicine
Get access

Summary

Introduction

Stroke is the third largest cause of death in Western countries. As the commonest form of long-term adult disability, it is a major consumer of health spending. Eighty percent of strokes are caused by ischemic infarcts and 20% by hemorrhages. Despite the magnitude of the problem, successful active treatment of ischemic stroke was almost non-existent until the mid 1990s. Medical management was predominantly prophylactic, particularly concentrated upon the control of hypertension. The role of diagnostic tests was limited to confirmation of stroke diagnosis, differentiation of infarct from hemorrhage, and identification of those entities that may present with stroke-like symptoms and signs (“pseudostroke”). Chronic subdural hematoma, slow-growing tumors, demyelination, and arteriovenous malformations are all potentially treatable lesions that may present as pseudostroke. As many as 20% of stroke-like presentations can be caused by entities other than stroke.[1]

Limitations of basic stroke-screening methods

The success of thrombolytic drugs, coupled with their potential adverse effects in some cases, highlights the need for tests that are highly sensitive and specific for diagnosis, and that provided information on which group of patients is most likely to respond to therapy. Tests that are sufficiently non-invasive for serial measurement of the effect of therapy are also required. Current diagnostic tools for the investigation of stroke have become increasingly sophisticated and non-invasive. The basic principle has been that when investigation has been clinically justified, the brain and the carotid vessels in the neck need to be imaged. The imaging modalities used vary according to those available at the imaging center. Computed tomography (CT) of the brain and duplex Doppler ultrasound of the carotid arteries was until recent years the mainstay of investigation. Magnetic resonance imaging (MRI) and MR angiography (MRA), or CT and CT angiography (CTA) performed with high-resolution multidetector CT machines are progressively replacing single-detector plain CT and ultrasound. Digital subtraction angiography (DSA) and its associated cost and morbidity are progressively being used only as a conduit to interventional procedures.

Type
Chapter
Information
Clinical MR Neuroimaging
Physiological and Functional Techniques
, pp. 169 - 172
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Libman, RB, Wirkowski, E, Alvir, J, Rao, TH.Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. Arch Neurol 1995; 52: 1119–1122.CrossRefGoogle ScholarPubMed
von Kummer, R, Meyding-Lamade, U, Forsting, M, et al. Sensitivity and prognostic value of early computed tomography in middle cerebral artery trunl occlusion. AJNR Am J Neuroradiol 1994; 15: 9–15.Google Scholar
Symon, L, Branston, NM, Strong, AJ, Hope, JD.The concepts of thresholds of ischemia in relation to brain structure and function. J Clin Pathol Suppl (R Coll Pathol) 1977; 11: 149–154.CrossRefGoogle ScholarPubMed
Astrup, J, Siesjo, BK, Symon, L.Thresholds in cerebral ischemia: the ischemic penumbra. Stroke 1981; 12: 723–725.CrossRefGoogle ScholarPubMed
Barber, PA, Davis, SM, Darby, DG, et al. Screening for thrombolytic therapy in acute stroke: diffusion-weighted imaging vs. computed tomography. Cerebrovasc Dis 1999; 9: 73.Google Scholar
Lovblad, KO, Laubach, HJ, Baird, AE, et al. Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 1998; 19: 1061–1066.Google ScholarPubMed
Wang, PY, Barker, PB, Wiutyk, RJ, et al. Diffusion-negative stroke: a report of two cases. AJNR Am J Neuroradiol 1999; 20: 1876–1880.Google ScholarPubMed
Darby, DG, Barber, PA, Gerraty, RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999; 30: 2043–2052.CrossRefGoogle ScholarPubMed
Rordorf, G, Koroshetz, WJ, Copen, WA, et al. Regional ischemia and ischemic injury in patients with acute middle cerebral artery stroke as defined by early diffusion-weighted and perfusion-weighted MRI. Stroke 1998; 29: 939–943.CrossRefGoogle ScholarPubMed
Pierpaoli, C, Jezzard, P, Basser, PJ, Barnett, A, Di Chiro, G.Diffusion tensor MR imaging of the human brain. Radiology 1996; 201: 637–648.CrossRefGoogle ScholarPubMed
Yang, Q, Tress, BM, Barber, PA, et al. Serial study of apparent diffusion coefficient and anisotropy in patients with acute stroke. Stroke 1999; 30: 2382–2390.CrossRefGoogle ScholarPubMed
Green, HA, Pena, A, Price, CJ, et al. Increased anisotropy in acute stroke: a possible explanation. Stroke 2002; 33: 1517–1521.CrossRefGoogle ScholarPubMed
Watanebe, T, Honda, Y, Fujii, Y, et al. Three-dimensional anisotropy contrast magnetic resonance axonography to predict the motor function in patients suffering from stroke. J Neurosurg 2001; 94: 955–960.CrossRefGoogle Scholar
Sorensen, AG, Buonanno, FS, Gonzalez, RG, et al. Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echo-planar imaging. Radiology 1996; 199: 391–401.CrossRefGoogle Scholar
Barker, PB, Gillard, JH, van Zijl, PC, et al. Acute stroke: evaluation with serial proton MR spectroscopic imaging. Radiology 1994; 192: 723–732.CrossRefGoogle ScholarPubMed
Pereira, AC, Saunders, DA, Doyle, VL, et al. Measurement of initial N-acetyl aspartate concentration by magnetic resonance spectroscopy and initial infarct volume by MRI predicts outcome in patients with middle cerebral artery territory infarction. Stroke 1999; 30: 1577–1582.CrossRefGoogle ScholarPubMed
Parsons, MW, Li, T, Barber, PA, et al. Combined (1)H MR spectroscopy and diffusion-weighted MR improves the prediction of stroke outcome. Neurology 2000; 55: 485–505.CrossRefGoogle ScholarPubMed
Wintermark, M, Maeder, P, Thiran, J-Ph, et al. Quantitative assessment of regional cerebral blood flows by perfusion CT studies at low injection rates: a critical review of the underlying theoretical models. Eur Radiol 2001; 11: 1220–1230.CrossRefGoogle ScholarPubMed
Wintermark, M, Maeder, P, Thiran, J-Ph, et al. Simultaneous measurements of regional cerebral blood flows by perfusion-CT and stable xenon-CT: a validation study. AJNR Am J Neuroradiol 2001; 22: 905–914.Google Scholar
Wintermark, M, Reichhart, M, Thiran, J-P, et al. Prognostic value of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients. Ann Neurol 2002; 51: 417–432.CrossRefGoogle ScholarPubMed
Wintermark, M, Reichhart, M, Cuisenaire, O, et al. Comparison of admission perfusion computed tomography and qualitative diffusion- and perfusion-weighted magnetic resonance imaging in acute stroke patients. Stroke 2002; 33: 2025–2031.CrossRefGoogle ScholarPubMed
Capildeo, R, Haberman, S, Rose, FC.The definition and classification of stroke. A new approach. Q J Med 1978; 47: 177–196.Google ScholarPubMed
Kidwell, CS, Alger, JR, Di Salle, F, et al. Diffusion MR in patients with transient ischemic attacks. Stroke 1999; 30: 1174–1180.CrossRefGoogle Scholar
National Institute of Neurological Disorders and Stroke, Stroke and Trauma Division. North American symptomatic carotid arterectomy trial (NASCET) Investigators. Clinical alert: benefit of carotid endarterectomy for patients with high grade stenosis of the internal carotid artery. Stroke 1991; 22: 816–817.CrossRefGoogle Scholar
van der Grand, J, Eikelboom, BC, Mali, WPTM. Flow-related anaerobic metabolic changes in patients with severe stenosis of the internal carotid artery. Stroke 1996; 27: 2026–2032.CrossRefGoogle Scholar
Kim, GE, Lee, JH, Cho, YP.Can carotid endarterectomy improve metabolic status in patients with asymptomatic internal carotid artery flow lesion? Studies with localized in vivo proton magnetic resonance spectroscopy. J Vasc Surg 2002; 36: 559–564.CrossRefGoogle ScholarPubMed
National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. New Eng J Med 1995; 333: 1581–1589.CrossRefGoogle Scholar
Furlan, A, Higashida, R, Weschler, L, et al. For the PROACT Investigators. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomised controlled trial. J Am Med Assoc 1999; 282: 2003–2011.CrossRefGoogle Scholar
Kane, I, Sandercock, P, Wardlaw, J.Magnetic resonance prefusion diffusion mismatch and thrombolysis in acute ischaemic stroke: a systematic review of the evidence to data. J Neurol Neurosurg Psychiatry 2007; 78: 485–491.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×