neuroradiology of hemorrhage stroke

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1、W.TaylorKimberly,HMS4GillianLieberman,MDJuly2003NeuroradiologyNeuroradiologyofHemorrhagicofHemorrhagicStrokeStrokeW.TaylorKimberlyHarvardMedicalSchoolYear4GillianLieberman,MDW.TaylorKimberly,HMS4GillianLieberman,MDGoals1.Mechanismsofstroke2.Whatneuroimagingmodalitiesareavailable3.Usesforneuroimaging

2、modalities4.Patientpresentationtoillustratethedecisionalgorithmforworkupofonetypeofstroke2W.TaylorKimberly,HMS4GillianLieberman,MDStrokepathogenesisIschemicstroke(80%)Thedeficitsadheretovesselterritories.Embolic:usuallycardiogenicinorigin,lesscommonlyartery-to-artery.Thrombotic:causedbyHTN,arteritid

3、es.Hemorrhagicstroke(20%)Intraparenchymalhemorrhage:causesincludeHTN,trauma,cocaine.Gradualonset,withneurologicfindingsthatmaycrossvesselterritories.Subarachnoidhemorrhage:causesincludearterialaneurysmandAVM.Suddenonset,excruciatingheadacheandchangesinmentalstatus.Rapiddiagnosisandinterventioniscrit

4、icalforpreservationofbrainfunction.3W.TaylorKimberly,HMS4GillianLieberman,MDMenuoftestsHeadCT●quick●sensitiveforhemorrhage●I+contrasttovisualizevascularanatomy●butcannotdetectacuteinfarction

5、entvisualizationofanatomy●sensitivetoacuteinfarct(T2,FLAIRandDWI/ADCsequences)●canseevesselflowwithMRA(betterwithgadoliniumcontrast)●butveryslowtoacquireimages●doesnotprovidevesselanatomy(willovercalltightstenoses)CerebralAngiogram●excellentvascularanatomy●permitsinterventions(clotretrieval,targeted

6、t-PAadministration,coilembolization)4W.TaylorKimberly,HMS4GillianLieberman,MDStrokeimagingalgorithmRuleoutstrokeHeadCTwithoutcontrastHemorrhageNohemorrhage,infarctormassesHTN,aneurysm,AVM?CTAMRI/MRAT1,T2,>6hrsoccludedFLAIR,>2hrsInterventionalneuroradsvesselDWI/ADC,>30minAngiogramtostudyanatomyHypera

7、cuteischemicstrokeIntervene,ifpossibleIf<3hrs,peripheralt-PACoilembolizationclotretrieval,directedt-PAadministrationTIMEISEVERYTHING!5W.TaylorKimberly,HMS4GillianLieberman,MDPatientPresentationJ.B.isa