Neuroimaging in Cerebrovascular Accidents

Abstract

Introduction: The incidence rate and the death rate from stroke increase dramatically with age. The one who survive are usually left with permanent disability. Thus, stroke has become a great medical and social problem. Accurate and early diagnosis may improve the morbidity and mortality rates in the future as newer and more effective therapies are currently being instituted. Neuroimaging in stroke patients, especially in acute ischemic stroke patients, plays an essential role. It helps to differentiate other causes of stroke (i.e., stroke mimics such as migraine headache, tumors, seizure, metabolic disturbance, and peripheral or cranial nerve disorders), early detection of hemorrhagic stroke, distinguish irreversible infarcted tissues from salvageable tissue, identify vascular malformations, treatment planning for intravenous thrombolysis and intra-arterial thrombectomy, and outcomes prediction. The aim of the study is to characterize type of stroke hemorrhagic vs. ischemic on neuroimaging. Radiological evaluation of stroke regarding –site, size, volume and duration. Correlation of neuroimaging findings with clinical findings and patient demographics. Materials and Methods: In 100 patient single-center, prospective observational study was conducted in the department of radiology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly and adult patients with suspected stroke on computed tomography (CT) and magnetic resonance imaging (MRI) and characterization and correlation with clinical findings were done from the study. Infarcts were grouped into hyperacute (0–24 hours), (acute 1–7 days), early subacute (7–10 days), late subacute (10–21 days) Results: Out of 100 patients, the study showed male predominance. The majority of cases had a history of weakness. Comorbidities like diabetes, hypertension, and dyslipidemia increase the risk of stroke On the basis of GCS score the majority of the cases were, having GCS score greater than 10 (72.0%). Cranial nerve palsies and LOC were also common among patients of stroke. Out of a total 69 ischemic stroke cases, CT was positive in 55 patients, while MRI was positive in all the cases. Arterial infarcts (89.8%) are much more common than the venous infarcts 7 cases (10.2%). The majority of cases that reached our department were in the acute stage (56 cases, 81.2%), and the majority had MCA territory involvedThe basal ganglia complex was the most common location for the hemorrhage and was seen in 15 cases (48.3%). The mean volume of bleeding was large in cases of lobar bleeding. There was a strong positive correlation between altered sensorium (Phi value .64) and vomiting (.60), while the symptoms showed a positive correlation. The correlation of cerebrovascular accidents with age was seen more in patients aged > 60 as compared to those age < 60 (Phi value .1). Conclusion: This study depicts the predominance of the older age group (> 40 years). The ischemic stroke was more common than the hemorrhagic stroke, the commonest cause being the MCA territory infarcts. In the cases of hemorrhagic stroke, the ganglion-capsular bleed was the commonest. Stroke imaging has undergone significant advances over last decade. It remains very crucial for the management of hyperacute stroke in the first few hours, where aim is to recognize patients eligible for thrombolytic therapy and expected to have good outcomes. Both CT, and MRI are useful for a comprehensive assessment of acute stroke MRI is sensitive for ischemic infarct detection and can provide important and necessary information for therapy planning. Both clinical examination and early diagnosis of stroke by imaging can lead to better patient outcomes.