Dwi | STROKE MANUAL

MR-DWI in the acute stroke diagnosis

Hemorrhagic transformation (DWI with T2 blackout)

NEUROIMAGING / MAGNETIC RESONANCE MR-DWI in the acute stroke diagnosis Created 24/05/2021, last revision 06/11/2023 [toc] Diffusion-weighted imaging (DWI) is a common MRI sequence for evaluating acute ischemic stroke. Increased DWI signal in ischemic brain tissue is usually observed within a few minutes after arterial occlusion. Technical notes ischemia leads to diffusion restriction due to ... Read more

Rostrocaudal deterioration

Brainstem death - all brainstem reflexes are absent

GENERAL NEUROLOGY Rostrocaudal deterioration Created 18/11/2023, last revision 25/11/2023 disorders of consciousness are caused by dysfunction of the ascending reticular activating system (ARAS) in the brainstem, its impaired connections with the cerebral cortex (reticulo-cortical pathways), or generalized cerebral dysfunction dysfunction in these areas can result in a spectrum of impaired consciousness, ranging from mild confusion ... Read more

Statin intolerance

ADD-ONS / MEDICATION Statin intolerance Created 14/11/2023, last revision 18/11/2023 [toc] NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient Abbreviations: ULN = upper limit of normal. CK = creatine kinase , LDL = low density lipoprotein, SAMS = statin associated muscle symptoms, ... Read more

Statins and their interactions

ISCHEMIC STROKE / PREVENTION Statins and their interactions Created 19/10/2023, last revision 18/11/2023 [toc] statins are competitive HMG-CoA reductase inhibitors that are effective in stroke prevention interactions of statins with other drugs affect their metabolism and can be clinically serious; they may be responsible for up to nearly 60% of statin-related myopathy/rhabdomyolysis cases Classification of ... Read more

Lipid-lowering therapy

ISCHEMIC STROKE / PREVENTION Lipid-lowering therapy Created 18/10/2023, last revision 06/12/2023 [toc] 2019 - ESC/EAS Guidelines for the Management of Dyslipidaemias dyslipidemia is a major modifiable vascular risk factor treatment with lipid-lowering agents (hypolipidemics) reduces the incidence of ischemic stroke and other atherosclerotic cardiovascular events (ASCVD) hypolipidemics (and their combinations) help to achieve target levels ... Read more

Overview of imaging modalities for an Acute Stroke

E-CTA (Brainomix) shows the left ICA and MCA occlusion

IMAGING METHODS Overview of imaging modalities for an Acute Stroke Created 14/09/2023, last revision 06/11/2023 historically, neuroimaging in patients with acute-onset neurological deficits has been used primarily to exclude hemorrhagic and nonvascular etiologies (e.g., neoplastic, infectious, etc.). over time, neuroimaging has become an essential part of acute stroke management and is used to: differentiate ischemic ... Read more

Prevention of ischemic stroke

ISCHEMIC STROKE Prevention of ischemic stroke Created 13/09/2023, last revision 21/10/2023 primary stroke prevention - interventions to reduce the risk of stroke in asymptomatic individuals secondary stroke prevention - interventions to reduce the risk of recurrent ischemic stroke in individuals who have already experienced a stroke or TIA; the management is based on the etiology ... Read more

Spinal cord vascular disorders

ADD-ONS / OTHER VASCULAR DISORDERS Spinal cord vascular disorders Created 14/07/2023, last revision 05/11/2023 [toc] Spinal cord vascular disorders usually present as neurologic emergencies and cause significant morbidity. Vascular causes include infarction, hemorrhage, and manifestation of various malformations. In the case of sudden lower limb paraparesis or tetraparesis, urgent imaging studies are critical to identify ... Read more

Vertebrobasilar stroke

ISCHEMIC STROKE Vertebrobasilar stroke Created 20/06/2023, last revision 06/11/2023 [toc] the vertebrobasilar (posterior) circulation comprises the vertebral, basilar, and posterior cerebral arteries, as well as their branches it supplies the posterior regions of the brain (brainstem, thalamus, cerebellum, and areas of the occipital and temporal lobes) the term vertebrobasilar insufficiency (VBI) describes inadequate blood flow ... Read more

Topical diagnosis of stroke

ISCHEMIC STROKE Topical diagnosis of stroke Created 20/06/2023, last revision 01/12/2023 [toc] Topical diagnosis in stroke refers to the localization of ischemia within the brain based on clinical signs and symptoms and neuroimaging. This approach helps to differentiate between different stroke subtypes, such as cortical versus subcortical strokes, or to identify specific vascular territories that ... Read more