Imaging strategy for acute stroke patients, a review of literature

Background: This review article focused on the utilization and impact of current neuroimaging techniques for the patient with acute stroke, emphasizing how imaging builds upon clinical assessment to establish diagnosis or etiology and guide therapeutic decisions.

When requesting imaging examinations in patients with stroke symptoms; it is crucial to evaluate four significant parameters of stroke; parenchyma, vessels, perfusion, and penumbra. Evaluation of all these four parameters, in their right request are essential to grasp the explanation and potential therapy decisions for stroke in a specific patient. Extensive neurovascular imaging conventions utilizing multimodality CT (NCCT, CT Angiography, and CT Perfusion) or multimodality MRI (DWI-perfusion mismatch or DWI-FLAIR mismatch, and MR Angiography) might be utilized to evaluate the acute stroke patients and provide all the needed data for treatment of them inside minutes after the patient lands at the emergency clinic. Using this approach will help to discriminate between hemorrhagic and ischemic stroke as presence of frank intracerebral hemorrhage contraindicates reperfusion treatment, permits the choice of patients with large vessel occlusion for endovascular treatment and answer the important “tissue clock” within 6 hours from symptom and even with late-presenting (> 6 h) or wake-up stroke.

Conclusions: As patients with acute cerebral stroke might be critically ill, the initial imaging scanning for acute stroke patients should be constrained to the procurement of useful data only, considering the accessible therapeutic options at a given place at any given time.