0:00

So, these are images of a 78 year old

0:03

with left-sided weakness,

0:05

and you can see that there's an area with

0:09

DWI hyperintensity, ADC hypointensity,

0:13

consistent with an acute to subacute infarction.

0:17

Notice that part of it,

0:18

along the periphery is already bright on ADC,

0:21

so there's some pseudonormalization.

0:23

When you're comparing the whole region of ADC

0:26

that FLAIR abnormality.

0:29

There's swelling in effacement sulci,

0:32

as you can see pretty well in the FLAIR,

0:33

here's a little bit of effacement

0:35

of the posterior horn of lateral ventricle,

0:37

and again, mixed ADC,

0:39

partly restricted, partly elevated.

0:40

And then when we look at the SWI images,

0:44

we can see this kind of confluent

0:46

little hemorrhages.

0:47

So, this is petechial hemorrhage

0:50

in a subacute infarction and

0:55

we also had some ASL images,

0:58

and you can see there's a matched,

1:00

relatively matched defect between the ASL

1:03

and the DWI.

1:06

So, that is good.

1:08

That means the infarct is probably not going to extend.

1:11

And then when we look at the MRA,

1:14

we can see that the MCA

1:16

looks pretty good on that side.

1:17

There's not approximal embolus.

1:20

So, match defect, subacute infarct,

1:23

petechial hemorrhage,

1:24

mass effect will not extend

1:26

because there's no tissue at risk.

Case - Subacute Stroke Evaluation (Case 2)

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0:00

So, these are images of a 78 year old

0:03

with left-sided weakness,

0:05

and you can see that there's an area with

0:09

DWI hyperintensity, ADC hypointensity,

0:13

consistent with an acute to subacute infarction.

0:17

Notice that part of it,

0:18

along the periphery is already bright on ADC,

0:21

so there's some pseudonormalization.

0:23

When you're comparing the whole region of ADC

0:26

that FLAIR abnormality.

0:29

There's swelling in effacement sulci,

0:32

as you can see pretty well in the FLAIR,

0:33

here's a little bit of effacement

0:35

of the posterior horn of lateral ventricle,

0:37

and again, mixed ADC,

0:39

partly restricted, partly elevated.

0:40

And then when we look at the SWI images,

0:44

we can see this kind of confluent

0:46

little hemorrhages.

0:47

So, this is petechial hemorrhage

0:50

in a subacute infarction and

0:55

we also had some ASL images,

0:58

and you can see there's a matched,

1:00

relatively matched defect between the ASL

1:03

and the DWI.

1:06

So, that is good.

1:08

That means the infarct is probably not going to extend.

1:11

And then when we look at the MRA,

1:14

we can see that the MCA

1:16

looks pretty good on that side.

1:17

There's not approximal embolus.

1:20

So, match defect, subacute infarct,

1:23

petechial hemorrhage,

1:24

mass effect will not extend

1:26

because there's no tissue at risk.

Report

Faculty

Pamela W Schaefer, MD, FACR

Professor of Radiology, Vice Chair of Education

Massachusetts General Hospital

Lesson

Pre-Course Activities

Lesson

Introduction to Stroke Imaging

Lesson

Noncontrast CT

Lesson

CTA Neck

Lesson

CTA Head

Lesson

CT Perfusion

Lesson

MRI (DWI, FLAIR, SWI) of Acute Stroke

Lesson

MRA of Head and Neck

Lesson

Multifocal Strokes With No Visualized Vascular Abnormality

Lesson

Brain Ischemia, Hypoxia, & Death

Lesson

Stroke Mimics & Other Causes of Restricted Diffusion

Lesson

MR Perfusion

Lesson

Subacute Stroke & Differentials

Case - Subacute Stroke Evaluation (Case 2)