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Brain Ischemia

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Recent Advances in Diagnostic Neuroradiology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

For a long time acute stroke has been a disease without specific therapeutic options and most therapies were concentrated on a general medical stabilization in the acute setting. This more fatalistic approach has changed dramatically since several studies have shown the efficacy of recanalization therapies in acute ischemic stroke patients. Under these circumstances, neuroradiology with its new modalities has become a major player in the diagnostic work-up but also in the therapeutic approach of acute stroke patients. However, for those who are working with stroke patients, it has become essential not only to understand the technology of their diagnostic tools but also to have enough knowledge about the pathophysiology of stroke itself. With this growing knowledge on the neuroradiologist’s part, and new techniques available, the neuroradiologist is able to look inside the ischemic disease and becomes a competent partner in the diagnostic and therapeutic discussion.

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References

  • Alexandrov AV, Masdeu JC, Devous Sr MD, Black SE, Grotta JC (1997) Brain single-photon emission CT with HMPAO and safety of thrombolytic therapy in acute ischemic stroke. Proceedings of the meeting of the SPECT Safe Thrombolysis Study Collaborators and the members of the Brain Imaging Council of the Society of Nuclear Medicine. Stroke 28:1830–1834

    Article  CAS  PubMed  Google Scholar 

  • Astrup J, Siesj+ B, Symon L (1981) Thresholds in cerebral ischemia-the ischemic penumbra. Stroke 12:723–725

    Article  CAS  PubMed  Google Scholar 

  • Barber PA, Darby DG, Desmond PM et al. (1998) Prediction of stroke outcome with echoplanar perfusion-and diffusion-weighted MRI. Neurology 51:418–426

    Article  CAS  PubMed  Google Scholar 

  • Baron JC, von Kummer R, deiZoppo GJ (1995) Treatment of acute ischemic stroke. Challenging the concept of a rigid and universal time window. Stroke 26:2219–2221

    Article  CAS  PubMed  Google Scholar 

  • Belliveau JW, Rosen BR, Kantor HL et al. (1990) Functional cerebral imaging by susceptibility-contrast NMR. Magn Reson Med 14:538–546

    Article  CAS  PubMed  Google Scholar 

  • Bozzao L, Bastianello S, Fantozzi LM, Angeloni U, Argentino C, Fieschi C (1989) Correlation of angiographic and sequential CT findings in patients with evolving cerebral infarction. AJNR 10:1215–1222

    CAS  PubMed  Google Scholar 

  • Bozzao L, Angeloni U, Bastianello S, Fantozzi LM, Pierallini A, Fieschi C (1991) Early angiographic and CT findings in patients with hemorrhagic infarction in the distribution of the middle cerebral artery. AJNR 12:1115–1121

    CAS  PubMed  Google Scholar 

  • Brandt T, Thie A, Caplan LR, Hacke W (1995) Infarcts in the brain areas supplied by the posterior cerebral artery. Clinical aspects, pathogenesis and prognosis. Nervenarzt 66:267–274

    CAS  PubMed  Google Scholar 

  • Brandt T, von Kummer R, Muller Kuppers M, Hacke W (1996) Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke 27:875–881

    Article  CAS  PubMed  Google Scholar 

  • Brandt T, Knauth M, Wildermuth S et al. (1999) CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia. Stroke 30:606–612

    Article  CAS  PubMed  Google Scholar 

  • Bruning R, Penzkofer H, Schopf U et al. (1998) Calculation of absolute cerebral blood volume and cerebral blood flow by means of electron-beam computed tomography (EBT) in acute ischemia. Radiologe 38:1054–1059

    Article  CAS  PubMed  Google Scholar 

  • Busto R, Dietrich WD, Globus MY-T et al. (1987) Small differences in intraischemic brain temperature critically determine the extent of ischemic injury. J Cereb Blood Flow Metab 7:729–738

    Article  CAS  PubMed  Google Scholar 

  • Davis M, Mendelow AD, Perry RH, Chambers IR, James OF (1995) Experimental stroke and neuroprotection in the aging rat brain. Stroke 26:1072–1078

    Article  CAS  PubMed  Google Scholar 

  • Diener HC (1998) Multinational randomised controlled trial oflubelozole in acute ischaemic stroke. Cerebrovasc Dis 8:172–181

    Article  CAS  PubMed  Google Scholar 

  • Doerfler A, Forsting M, Reith W et al. (1996) Decompressive surgery in a rat model of “malignant” cerebral hemispherical stroke: experimental support for an aggressive therapeutic approach. J Neurosurg 85:853–859

    Article  CAS  PubMed  Google Scholar 

  • Doerfler A, Engelhorn T, von Kummer R et al. (1998) Are iodinated contrast agents detrimental in acute cerebral ischemia? An experimental study in rats. Radiology 206:211–217

    CAS  PubMed  Google Scholar 

  • Donnan GA, Davis SM, Chambers BR et al. (1995) Trials of streptokinase in severe acute ischaemic stroke. Lancet 345:578–579

    Article  CAS  PubMed  Google Scholar 

  • Fisher M, Albers GW (1999) Applications of diffusion-perfusion magnetic resonance imaging in acute ischemic stroke. Neurology 52:1750–1756

    Article  CAS  PubMed  Google Scholar 

  • Forsting M, Reith W, Schabitz WR et al. (1995) Decompressive craniectomy for cerebral infarction. An experimental study in rats. Stroke 26:259–264

    Article  CAS  PubMed  Google Scholar 

  • Frank JI, Krieger D, Chyatte D, Cancian S (1999) HEADDFIRST: Hemicraniectomy and durotomy upon deterioration from massive hemispheric infarctions. A proposed multicenter, prospective, randomized study. 24th American Heart Association International Conference on Stroke and Cerebral Circulation. Nashville, Tennessee, USA

    Google Scholar 

  • Gillard JH, Barker PB, van Zijl PC, Bryan RN, Oppenheimer SM (1996) Proton MR spectroscopy in acute middle cerebral artery stroke. AJNR 17:873–886

    CAS  PubMed  Google Scholar 

  • Gilman S (1998) Imaging the brain. First of two parts. N Engl J Med 338:812–820

    Article  CAS  PubMed  Google Scholar 

  • Gilman S (1998) Imaging the brain. Second of two parts. N Engl J Med 338:889–896

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Schwab S, DeGeorgia M (1994) Intensive care of acute ischemic stroke. Cerebrovasc Dis 4:384–392

    Article  Google Scholar 

  • Hacke W, Kaste M, Fieschi C et al. (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study. JAMA 274:1017–1025

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Stingele R, Steiner T, Schuchardt V, Schwab S (1995) Critical care of acute ischemic stroke. Intensive Care Med 21:856–862

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53:309–315

    Article  CAS  PubMed  Google Scholar 

  • Hacke W, Steiner T, Schwab S (1996) Critical management of the acute stroke: Medical and surgical therapy. In: Batjer HH, Caplan LR, Freiberg L, Greenlee RG, Jr., Kopitnik TH, Jr. and Young WL (eds) Cerebrovascular Disease. Lippincott-Raven, Hagerstown, pp 523–533

    Google Scholar 

  • Hacke W, Kaste M, Fieschi C et al. (1998) Randomised doubleblind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352:1245–1251

    Article  CAS  PubMed  Google Scholar 

  • Hamberg LM, Hunter GJ, Halpern EF, Hoop B, Gazelle GS, Wolf GL (1996) Quantitative high-resolution measurement of cerebrovascular physiology with slip-ring CT. AJNR 17:639–650

    CAS  PubMed  Google Scholar 

  • Hamberg LM, Hunter GJ, Kierstead D, Lo EH, GilbertoGonzalez R, Wolf GL (1996) Measurement of cerebral blood volume with subtraction three-dimensional functional CT. AJNR 17:1861–1869

    CAS  PubMed  Google Scholar 

  • Hasegawa Y, Fisher M, Latour LL, Dardzinski BJ, Sotak CH (1994) MRI diffusion mapping of reversible and irreversible ischemic injury in focal brain ischemia. Neurology 44:1484–1490

    Article  CAS  PubMed  Google Scholar 

  • Heiss WD, Grond M, Thiel A et al. (1998) Tissue at risk of infarction rescued by early reperfusion: a positron emission tomography study in systemic recombinant tissue plasminogen activator thrombolysis of acute stroke. J Cerebr Blood Flow Met 18:1298–1307

    Article  CAS  Google Scholar 

  • Horowitz SH, Zito JL, Donnarumma R, Patel M, Alvir J (1991) Computed tomographic-angiographic findings within the first five hours of cerebral infarction. Stroke 22:1245–1253

    Article  CAS  PubMed  Google Scholar 

  • Jansen O, Schellinger PD, Fiebach JB, Hacke W, Sartor K (1999) Early recanalization in acute ischemic stroke saves tissue at risk defined by MRI. Lancet 353:2036–2037

    Article  CAS  PubMed  Google Scholar 

  • Kidwell CS, Alger JR, Di Salle F et al. (1999) Diffusion MRI in patients with transient ischemic attacks. Stroke 30:1174–1180

    Google Scholar 

  • Knauth M, Forsting M, Hartmann M, Heiland S, Balzer T, Sartor Ks (1996) MR enhancement of brain lesions: Increased contrast dose compared with magnetization transfer. AJNR 17:1853–1859

    CAS  PubMed  Google Scholar 

  • Knauth M, Kummer RV, Jansen O, Haehnel S, Doerfler A, Sartor K (1997) Potential of CT angiography in acute ischemi stroke. AJNR 18:1001–1010

    CAS  PubMed  Google Scholar 

  • Koenig M, Klotz E, Luka B, Venderink DJ, Spittler JF, Heuser L (1998) Perfusion CT of the brain: diagnostic approach for early detection of ischemic stroke. Radiology 209:85–93

    CAS  PubMed  Google Scholar 

  • Leys D, Pruvo JP, Godefroy O, Rondepierre P, Leclerc X (1992) Prevalence and significance of hyperdense middle cerebral artery in acute stroke. Stroke 23:317–324

    Article  CAS  PubMed  Google Scholar 

  • Manelfe C, Larrue V, von Kummer R et al. (1999) Association of hyperdense middle cerebral artery sign with clinical outcome in patients treated with tissue plasminogen activator. Stroke 30:769–772

    Article  CAS  PubMed  Google Scholar 

  • Marks MP, Tong D, Beaulieu C, Albers G, de Crespigny A, Moseley ME (1999) Evaluation of early reperfusion and IV rt-PA therapy using diffusion-and perfusion-weighted MRI. Neurology 52:1792–1798

    Article  CAS  PubMed  Google Scholar 

  • Mohr JP, Biller J, Hilal SK et al. (1995) Magnetic resonance versus computed tomographic imaging in acute stroke. Stroke 26:807–812

    Article  CAS  PubMed  Google Scholar 

  • Mori E, Tabuchi M, Yoshida T, Yamadori A (1988) Intracarotid urokinase with thromboembolic occlusion of the middle cerebral artery. Stroke 19:802–812

    Article  CAS  PubMed  Google Scholar 

  • Mori E, Yoneda Y, Tabuchi M et al. (1992) Intravenous recombinant tissue plasminogen activator in acute carotid artery territory stroke. Neurology 42:976–982

    Article  CAS  PubMed  Google Scholar 

  • Moseley ME, Kucharczyk J, Mintorovitch J et al. (1990) Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR 11:423–429

    CAS  PubMed  Google Scholar 

  • Moseley ME, Wendland MF, Kucharczyk J (1991) Magnetic resonance imaging of diffusion and perfusion. Top Magn Reson Imaging 3:50–67

    CAS  PubMed  Google Scholar 

  • Multicenter Acute Stroke Trial-Europe Study Group (1996) Thrombolytic therapy with streptokinase in acute ischaemic stroke. N Engl J Med 335:145–150

    Article  Google Scholar 

  • Multicentre Acute Stroke Trial-Italy (MAST-I) Group (1995) Randomized controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 356:1509–1514

    Google Scholar 

  • Patel MR, Edelman RR, Warach S (1996) Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 27:2321–2324

    Article  CAS  PubMed  Google Scholar 

  • PROACT II Investigators (1999) PROACT II: Recombinant prourokinase (r-ProUK) in acute cerebral thromboembolism. Initial trial results. 24th American Heart Association International Conference on Stroke and Cerebral Circulation. Nashville, Tennessee, USA

    Google Scholar 

  • Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, Schuchardt V, Hacke W (1995) Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 23:1576–1587

    Article  CAS  PubMed  Google Scholar 

  • Rother J, de Crespigny AJ, H DA, Iwai K, Moseley ME (1996) Recovery of apparent diffusion coefficient after ischemiainduced spreading depression relates to cerebral perfusion gradient. Stroke 27:980–986

    Article  CAS  PubMed  Google Scholar 

  • Schellinger P, Steiner T (1998) Emergency and intensive-care treatment after a stroke. Recommendations of the European Consensus Group. Nervenarzt 69:530–539

    Article  CAS  PubMed  Google Scholar 

  • Schellinger PD, Jansen O, Fiebach JB, Hacke W, Sartor K (1999) A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. Stroke 30:765–768

    Article  CAS  PubMed  Google Scholar 

  • Schlaug G, Siewert B, Benfield A, Edelman RR, Warach S (1997) Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology 49:113–119

    Article  CAS  PubMed  Google Scholar 

  • Schriger DL, Kalafut M, Starkman S, Krueger M, Saver JL (1998) Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy. JAMA 279:1293–1297

    Article  CAS  PubMed  Google Scholar 

  • Schwab S, Spranger M, Schwarz S, Hacke W (1997) Barbiturate coma in severe hemispheric stroke: useful or obsolete? Neurology 48:1608–1613

    Article  CAS  PubMed  Google Scholar 

  • Schwab S, Steiner T, Aschoff A et al. ( ) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893

    Google Scholar 

  • Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W (1998) Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 29:2461–2466

    Article  CAS  PubMed  Google Scholar 

  • Schwamm LH, Koroshetz WJ, Sorensen AG et al. (1998) Time course of lesion development in patients with acute stroke. Serial diffusion-and hemodynamic-weighted magnetic resonance imaging. Stroke 29:2268–2276

    Article  CAS  PubMed  Google Scholar 

  • Shrier DA, Tanaka H, Numaguchi Y, Konno S, Patel U, Shibata D (1997) CT angiography in the evaluation of acute stroke. AJNR 18:1011–1020

    CAS  PubMed  Google Scholar 

  • Sorensen AG, Buonanno FS, Gonzalez RG et al. (1996) Hyperacute stroke: evaluation with combined multisection diffusion-weighted and hemodynamically weighted echoplanar MR imaging. Radiology 199:391–401

    CAS  PubMed  Google Scholar 

  • Steiner T, Mendoza G, De Georgia M et al. (1997) Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke 28:711–715

    Article  CAS  PubMed  Google Scholar 

  • Steiner T, Bluhmki E, Kaste M et al. (1998) The ECASS 3-hour cohort. Secondary analysis of ECASS data by time stratification. Cerebrovasc Dis 8:198–203

    Article  CAS  PubMed  Google Scholar 

  • The ATLANTIS Stroke Study Investigators (1999) The ATLANTIS rt-PA (Alteplase) acute stroke trial: final results. 24th American Heart Association International Conference on Stroke and Cerebral Circulation. Nashville, Tennessee, USA

    Google Scholar 

  • The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Google Scholar 

  • Tomsick TA, Brott TG, Chambers AA et al. (1990) Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis. AJNR 11:473–477

    CAS  PubMed  Google Scholar 

  • Tomsick T, Brott T, Barsan W et al. (1996) Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy. AJNR 17:1–7

    Google Scholar 

  • Tomura N, Uemura K, Inugami A, Fujita H, Higano S, Shishido F (1988) Early CT finding in cerebral infarction: obscuration of the lentiform nucleus. Radiology 168:463–467

    CAS  PubMed  Google Scholar 

  • Tong DC, Yenari MA, Albers GW, M OB, Marks MP, Moseley ME (1998) Correlation of perfusion-and diffusionweighted MRI with NIHSS score in acute ‘6.5 hour) ischemic stroke. Neurology 50:864–870

    Article  CAS  PubMed  Google Scholar 

  • Truwit CL, Barkovich AJ, Gean-Marton A, Hibri N, Norman D (1990) Loss of the insular ribbon: another early CT sign of acute middle cerebral artery infarction. Radiology 176:801–806

    CAS  PubMed  Google Scholar 

  • Ueda T, Hatakeyama T, Kumon Y, Sakaki S, Uraoka T (1994) Evaluation of risk of hemorrhagic transformation in local intra-arterial thrombolysis in acute ischemic stroke by initial SPECT. Stroke 25:298–303

    Article  CAS  PubMed  Google Scholar 

  • Ulug AM, Beauchamp Jr N, Bryan RN, van Zijl PCM (1997) Absolute quantitation of diffusion constants in human. stroke 28:483–490

    Article  CAS  PubMed  Google Scholar 

  • von Kummer R, Meyding-Lamade U, Forsting M et al. (1994) Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR 15:9–15

    Google Scholar 

  • von Kummer R, Bozzao L, Manelfe C (eds) (1995) Early CT diagnosis of hemispheric brain infarction (1st ed). Springer Verlag, Berlin, pp 1–95

    Google Scholar 

  • von Kummer R, Nolte PN, Schnittger H, Thron A, Ringelstein EB (1996) Detectability of cerebral hemisphere ischaemic infarcts by CT within 6 h of stroke. Neuroradiology 38:31–33

    Article  Google Scholar 

  • von Kummer R, Allen KL, Holle R et al. (1997) Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology 205:327–333

    Google Scholar 

  • von Kummer R (1998) Effect of training in reading CT scans on patient selection for ECASS II. Neurology 51(Suppl 3):S50–S52

    Article  Google Scholar 

  • Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR (1995) Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging. Ann Neurol 37:231–241

    Article  CAS  PubMed  Google Scholar 

  • Warach S, Boska M, Welch KM (1997) Pitfalls and potential of clinical diffusion-weighted MR imaging in acute stroke. Stroke 28:481–482

    CAS  PubMed  Google Scholar 

  • WHO Task Force (1989) Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on stroke and other cerebrovascular disorders. Stroke 20:1407–1431

    Article  Google Scholar 

  • Wiesmann M, Mayer T, Yousry I et al. (1999) Comparison of FLAIR and Fast Spin-Echo MR Imaging at 1.5 T for detection of acute subarachnoid hemorrhage. Joint Annual Meeting of the American Society of Neuroradiology. San Diego, CA, USA

    Google Scholar 

  • Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W (1998) Role of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 29:935–938

    Article  CAS  PubMed  Google Scholar 

  • Zeumer H (1985) Vascular recanalizing technique in interventional neuroradiology. J Neurol 231:287–294

    Article  CAS  PubMed  Google Scholar 

  • Zeumer H, Freitag HJ, Zanella F, Thie A, Arning C (1993) Local intra-arterial fibrinolytic therapy in patients with stroke: urokinase versus recombinant tissue plasminogen activator (r-TPA). Neuroradiology 35:159–162

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroradiology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Olav Jansen MD & Peter D. Schellinger MD

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  1. Olav Jansen MD
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  2. Peter D. Schellinger MD
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Editors and Affiliations

  1. Department of Radiology, University Hospitals K.U.L., Herestraat 49, 3000, Leuven, Belgium

    Philippe Demaerel MD, PhD (Professor) (Professor)

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© 2001 Springer-Verlag Berlin Heidelberg

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Jansen, O., Schellinger, P.D. (2001). Brain Ischemia. In: Demaerel, P. (eds) Recent Advances in Diagnostic Neuroradiology. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56662-2_10

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  • DOI: https://doi.org/10.1007/978-3-642-56662-2_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-63003-3

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