ABSTRACT
Ischemic stroke is a significant public health concern, with its incidence expected to double over the next 40 years, particularly among individuals over 75 years old. Previous studies, such as the DAWN trial, have highlighted the importance of correlating clinical severity with ischemic stroke volume to optimize patient management. Our study aimed to correlate the clinical severity of ischemic stroke, as assessed by the NIHSS score, with ischemic stroke volume measured using DWI, and short-term prognosis quantified by the mRS score at discharge. Conducted at the largest hospital in Gorj County from January 2023 to December 2023, this study enrolled 43 consecutive patients with acute ischemic stroke. In our patient cohort, we observed a strong positive correlation between NIHSS score and ischemic stroke volume (Spearman correlation coefficient = 0.982, p < 0.01), and a strong negative correlation between ASPECTS-DWI score and mRS score (Spearman correlation coefficient = -0.952, p < 0.01). Multiple linear regression analysis revealed a significant collective relationship between ASPECTS score, ischemic stroke volume, and NIHSS score (F(1, 41) = 600.28, p < 0.001, R2 = 0.94, R2adj = 0.93). These findings underscore the importance of DWI in assessing ischemic stroke severity and prognosis, warranting further investigation for its integration into clinical practice.
ABSTRACT
Arterial dissection is the result of blood entering along the intima-media plane through a breach produced either spontaneously or traumatically. Cervical arterial dissections are an important cause of acute ischemic stroke in children, young adults, and patients with cranio-cervical traumatic injuries. Arterial dissections occur either spontaneously, in genetic diseases, the most important association being with fibromuscular dysplasia. In most of the cases dissection involve the extracranial portions of the internal carotid and vertebral arteries. Magnetic resonance with T1 fat-saturation (T1 FS) sequence of the cervical region or computed tomography (CT) with computed tomography angiography (CTA) shows a very high sensitivity and specificity in the diagnosis of cervical artery dissections. Therapeutic options are still debatable in patients with acute ischemic stroke and vertebral or carotid artery dissection.
ABSTRACT
Watershed strokes have been described previously as ischemic strokes located in vulnerable border zones between brain tissue supplied by the anterior, posterior, and middle cerebral arteries in the distal junction between two non-anastomotic arterial territories. Ischemic strokes in border zones are well-recognized entities and well-described in terms of imaging features, but the pathophysiological mechanism of brain injury production is not fully defined. Border zone ischemia is caused by cerebral hypoperfusion through decreased cerebral blood flow and arterial embolism in unstable atheroma plaque. It is often difficult to say which mechanisms are fully responsible for producing cerebral ischemic lesions. This review aimed to highlight the imaging aspect of watershed strokes and to correlate the clinical characteristics of this type of stroke with the diagnostic algorithm for optimal therapeutic management. Neurologists should promptly recognize this type of stroke and investigate its etiology in the shortest possible time.