Neuroimaging in Acute Stroke

Bijoy K. Menon, MD, DM, MSc, FRCPC Cerebrovascular Disease p. 287-309 April 2020, Vol.26, No.2 doi: 10.1212/CON.0000000000000839
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PURPOSE OF REVIEW This article describes how imaging can be used by physicians in diagnosing, determining prognosis, and making appropriate treatment decisions in a timely manner in patients with acute stroke.

RECENT FINDINGS Advances in acute stroke treatment, including the use of endovascular thrombectomy in patients with large vessel occlusion and, more recently, of IV thrombolysis in an extended time window, have resulted in a paradigm shift in how imaging is used in patients with acute stroke. This paradigm shift, combined with the understanding that “time is brain,” means that imaging must be fast, reliable, and available around the clock for physicians to make appropriate clinical decisions. CT has therefore become the primary imaging modality of choice. Recognition of a large vessel occlusion using CT angiography has become essential in identifying patients for endovascular thrombectomy, and techniques such as imaging collaterals on CT angiography or measuring blood flow to predict tissue fate using CT perfusion have become useful tools in selecting patients for acute stroke therapy. Understanding the use of these imaging modalities and techniques in dealing with an emergency such as acute stroke has therefore become more important than ever for physicians treating patients with acute stroke.

SUMMARY Imaging the brain and the blood vessels supplying it using modern tools and techniques is a key step in understanding the pathophysiology of acute stroke and making appropriate and timely clinical decisions.

Address correspondence to Dr Bijoy Menon, 1079 29th St NW, Calgary, AB, Canada T3H4J2, docbijoymenon@gmail.com.

RELATIONSHIP DISCLOSURE: Dr Menon has received research/grant support from Alberta Innovates, the Canadian Institutes of Health Research (363959), and the Heart and Stroke Foundation of Canada. Dr Menon has held stock in Circle Neurovascular Imaging Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Menon reports no disclosure.

© 2020 American Academy of Neurology.