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1、JeremiahScharfGillianLieberman,MDApril2001ImagingModalitiesinAcuteStroke:TimeisBrainJeremiahScharf,HarvardMedicalSchool,MSIVGillianLieberman,MDBethIsrael-DeaconessMedicalCenterDepartmentofRadiologyJeremiahScharfGillianLieberman,MDStroke-DefinitionandStatistics°Acute,
2、vascularinjurytoCNS<24hrs=TIA>24hrs=stroke(CVA)°Affects600,000people/yr(thatis1strokeperminute!)°Is#3causeofmortalityinadultshttp://www.swmed.edu/stars/resources/stroke.html°Is#1causeofdisability2JeremiahScharfGillianLieberman,MDTypesofStroke°Hemorrhagic(20%)°usually
3、hypertensivehemorrhage°Ischemic(80%)°Thrombotic(40%)°intracerebralatherosclerosis°Embolic(60%)°Cardiacembolus(thrombus,tumor,septicembolus)°artery-to-artery(mainlycarotidthrombus)°Paradoxicalembolus(thrombus,fat,air)3JeremiahScharfGillianLieberman,MDRiskFactorsforStr
4、oke°Atherosclerosisriskfactors°FamilyhistoryofCVA,TIA,orMI°Hypertension°Smoking°Diabetes°Hypercholesterolemia°PreviousCVA,TIA,orMI°Atrialfibrillation4JeremiahScharfGillianLieberman,MDOurPatient-BF°86yoFw/HxofHTN,CADs/pMI,andhighcholesterol°presentedtoPCPforroutinevis
5、it°Felt“funny”->beganseizing°InED,unresponsive,L.sidedhemiplegiaeyesdeviatedtotheright5JeremiahScharfGillianLieberman,MDDifferentialDiagnosis°ManyCNSdiseasescanmimicischemicstroke°Hemorrhage°Masslesion(tumor,abscess,AVM)°Seizure(Todd’sparalysis)°Hemiplegicmigraine°MS
6、flare°Venousinfarct6JeremiahScharfGillianLieberman,MDGoalsofImaginginAcuteStroke1.Ruleinoroutotherdiseaseprocesses2.Definelocation,extentandageofinfarct3.DosoasrapidlyaspossibleTIMEISBRAIN7JeremiahScharfGillianLieberman,MDCerebrovascularAnatomyPosteriorAnteriorCircul
7、ationCirculation8MGHHandbookofNeurologyJeremiahScharfGillianLieberman,MDAnatomyoftheAnteriorCirculationAnteriorcerebralarteryMiddlecerebralarteryInternalcarotidarteryAnteriorcerebralarteryMiddlecerebralarteryInternalcarotidarteryMGHHandbookofNeurologyHighYieldNeurosc
8、ience9JeremiahScharfGillianLieberman,MDVascularterritoriesinthebrain10MGHHandbookofNeurologyJeremiahScharfGillianLieberman,MDImagin
