0:01

So now, I'm going to talk about how I designed

0:04

this course to maximize your learning.

0:07

The first thing we're going to do

0:07

is talk about vascular anatomy.

0:09

If you don't understand the pipes,

0:11

or the vessels, you're going to have

0:12

a hard time understanding stroke.

0:14

You need to know the major stroke territories,

0:17

and the clinical syndromes produced by

0:19

those strokes so that you can recognize them

0:22

and differentiate them from stroke mimics.

0:24

You need to understand the

0:25

concept of core and penumbra.

0:27

Core is the tissue that's dead on arrival,

0:30

and penumbra is the tissue that will

0:31

die if you, uh, don't recognize it and

0:36

attempt to treat it as quickly as possible.

0:39

We're going to talk first about CT, and

0:41

that's because non-contrast CT is usually

0:43

the first imaging modality around the world.

0:48

MR is more sensitive and specific, but

0:50

many more people have access to CTs.

0:53

We'll talk about non-contrast CT, and

0:55

then we're going to talk about CTA.

0:58

CT will help you look at the tissue.

1:00

CTA will help you identify

1:02

the problem with the pipes.

1:04

We're going to talk about large vessel

1:06

vasculopathies, we'll talk about neck CTA,

1:09

and then we'll talk about head CTA, and um,

1:12

how it's used for identifying disease entities

1:16

with multiple cervical stenosis, how it's used

1:19

identifying vessel occlusion and collaterals.

1:22

And then we're going to talk about CT perfusion,

1:26

um, a little bit about the MAP construction.

1:29

And then, um, the pathophysiology and how you

1:34

can use CT perfusion to identify that core and

1:37

improve detection of that core over non-contrast

1:39

CT, and how you can identify the penumbra and

1:42

the importance of the core-penumbra mismatch

1:45

in, um, patient selection for thrombolysis.

1:49

And then after we talk about the CT

1:51

pathway, we'll talk about the MRI pathway.

1:53

We're going to talk about DWI first.

1:56

Um, it is the most accurate method

1:58

of identifying, um, infarct core.

2:02

We'll talk about the importance of, uh,

2:05

flare, blood-brain barrier breakdown,

2:09

and SWI in detection of hemorrhage and in

2:12

detection of vessel occlusion and collaterals.

2:15

Then we'll go talk about MRA of the

2:16

head and neck, and we'll compare it to

2:19

CTA in terms of identifying multifocal

2:24

circle of well stenoses, accuracy.

2:27

Um, in thrombus detection, in collaterals, and

2:31

then we're going to talk about a newer technique

2:33

called vessel wall imaging, which helps with

2:35

us, uh, helps us to make some diagnoses such

2:38

as, um, primary CNS, angiitis, um, et cetera.

2:44

And then we're going to talk about,

2:46

uh, entities that you can really only

2:49

make the diagnosis on MRI, um, because

2:53

the CT is relatively unremarkable, and

2:56

the CTA is relatively unremarkable.

2:58

And, um, those will be things like cardiombolic

3:01

stroke, catastrophic success, and fat emboli.

3:06

Then we're going to talk about hypoxia

3:07

and hypoperfusion, the imaging findings

3:11

in those entities, and the more specific

3:15

imaging findings that go along with

3:17

the clinical diagnosis of brain death.

3:20

Now once we've pretty much gone through

3:23

All of those imaging modalities, we're

3:24

going to talk about stroke mimics.

3:26

Other causes of restricted diffusion that

3:28

are treated very differently from stroke.

3:31

We'll go through those in detail.

3:34

Um, we'll then talk about MR perfusion.

3:36

There are two different types.

3:37

You can inject contrast.

3:39

And we'll talk about how that's

3:41

used in combination with DWI.

3:45

Um, to look at the core penumbra

3:47

paradigm with MR imaging.

3:48

Um, Um, because some centers go directly

3:52

to MR, um, and use that paradigm instead of

3:55

CT, although CT, the CT paradigm is used.

3:58

much more commonly worldwide.

4:01

ASL is maybe not quite as good as MR perfusion

4:07

with contrast, but we don't need contrast.

4:10

We'll talk about the current uses of that.

4:12

And lastly, we'll talk about stroke

4:16

in its subacute form and how to

4:18

differentiate that from some mimics,

4:20

such as venous infarction and tumor.