RESUMO
INTRODUCTION: Urgent clinical assessment and brain imaging are essential for differentiating stroke mimics from stroke and to avoid unnecessary initiation of reperfusion and other therapies in stroke mimic patients. AREAS COVERED: In this article, the authors will review acute stroke imaging and then the imaging patterns of the most common stroke mimics. The authors have focused our review on brain CT scan, and more specifically CT perfusion, as this is the most commonly available and emerging tool in emergency settings. The authors also provide information on acute brain MRI and MR perfusion. EXPERT OPINION: Imaging can contribute to the detection and diagnosis of acute stroke mimics. Knowledge of imaging findings in different stroke mimics can help distinguish these from patients with stroke who require timely reperfusion therapy. CT and MRI perfusion and diffusion-weighted imaging (DWI) MRI are useful imaging modalities for the assessment of acute stroke patients as they provide more accurate information than plain CT scan. Some of these modalities should be available in the emergency setting. The authors recommended CT perfusion as a useful tool for stroke management and differentiation with stroke mimics.
Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Reperfusão , Acidente Vascular Cerebral/diagnóstico por imagemRESUMO
A patient presented with recurrent severe pseudotumor cerebri (PTC). Transverse sinus stenting is a very effective treatment option, however stenosis and intracranial hypertension can recur. In our patient, stenting initially resulted in resolution of papilloedema. However, after 5â years, a new stenosis developed which required further stenting. This case highlights the fact that, in patients with PTC who undergo transverse sinus stenting, a small proportion require repeat treatment due to formation of a new stenosis, usually adjacent to the existing stent. Patients with severe disease, such as ours, may be at higher risk of recurrence. Regardless of the severity, all patients who undergo stenting should have regular ocular follow-up.
Assuntos
Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/terapia , Stents , Seios Transversos , Adulto , Angiografia Cerebral , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/terapia , Diagnóstico Diferencial , Feminino , Humanos , Angiografia por Ressonância Magnética , Obesidade/complicações , Papiledema/etiologia , Papiledema/terapia , Pseudotumor Cerebral/diagnóstico por imagem , Recidiva , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/terapiaRESUMO
We report a case of a 72-year-old man who had undergone elective stenting of an asymptomatic high grade stenosis of the proximal left internal carotid artery. The indication was progression of the stenosis over a 3â year period despite receiving maximal medical therapy, and patient preference for stenting over endarterectomy. He became profoundly hypotensive in the immediate post-stent period and required immediate and prolonged vasopressor support over the next week. The etiological hypothesis is baroreceptor hyperactivity related to procedure induced unilateral stretching of the carotid body.
Assuntos
Artéria Carótida Interna/patologia , Estenose das Carótidas/terapia , Procedimentos Endovasculares/efeitos adversos , Hipotensão/etiologia , Stents , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , MasculinoRESUMO
A patient presented with recurrent severe pseudotumor cerebri (PTC). Transverse sinus stenting is a very effective treatment option, however stenosis and intracranial hypertension can recur. In our patient, stenting initially resulted in resolution of papilloedema. However, after 5â years, a new stenosis developed which required further stenting. This case highlights the fact that, in patients with PTC who undergo transverse sinus stenting, a small proportion require repeat treatment due to formation of a new stenosis, usually adjacent to the existing stent. Patients with severe disease, such as ours, may be at higher risk of recurrence. Regardless of the severity, all patients who undergo stenting should have regular ocular follow-up.
Assuntos
Constrição Patológica/etiologia , Papiledema/tratamento farmacológico , Pseudotumor Cerebral/patologia , Stents/efeitos adversos , Seios Transversos/patologia , Transtornos da Visão/tratamento farmacológico , Adulto , Feminino , Gadolínio/administração & dosagem , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Papiledema/complicações , Papiledema/patologia , Inibidores da Agregação Plaquetária/administração & dosagem , Náusea e Vômito Pós-Operatórios , Pseudotumor Cerebral/complicações , Recidiva , Zumbido/etiologia , Seios Transversos/cirurgia , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/patologiaRESUMO
We report a case of a 72-year-old man who had undergone elective stenting of an asymptomatic high grade stenosis of the proximal left internal carotid artery. The indication was progression of the stenosis over a 3 year period despite receiving maximal medical therapy, and patient preference for stenting over endarterectomy. He became profoundly hypotensive in the immediate post-stent period and required immediate and prolonged vasopressor support over the next week. The etiological hypothesis is baroreceptor hyperactivity related to procedure induced unilateral stretching of the carotid body.