Computed tomography perfusion in stroke mimics

2019 ◽  
Vol 15 (3) ◽  
pp. 299-307 ◽  
Author(s):  
James E Siegler ◽  
Jon Rosenberg ◽  
Daniel Cristancho ◽  
Andrew Olsen ◽  
Johannes Pulst-Korenberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Transient Ischemic Attack ◽  
Clinical Symptoms ◽  
Treatment Decision ◽  
Residue Function ◽  
Stroke Treatment ◽  
Computed Tomography Perfusion ◽  
Treatment Decision Making ◽  
Stroke Mimic ◽  
Ischemic Attack

Objective To describe the prevalence and patterns of abnormal findings on automated computed tomography perfusion in patients with stroke mimic. Methods We reviewed a retrospective multi-site cohort of consecutive patients undergoing computed tomography perfusion for suspected acute ischemic stroke within 24 h from last normal (June 2017 to December 2017). The primary outcome was the diagnosis of stroke mimic. Hypoperfusion abnormalities on iSchemaView RAPID automated computed tomography perfusion were compared between patients with stroke/transient ischemic attack and stroke mimic using mixed-effects multivariable logistic regression, focusing on absence of perfusion abnormalities and discordance with clinical symptoms and computed tomography angiography findings. Results Of 410 consecutive patients who underwent computed tomography perfusion, 348 met inclusion criteria (178 (51%) stroke, 19 (6%) transient ischemic attack, and 151 (43%) mimic). Time-to-maximum of the tissue residue function (Tmax>6s) abnormalities were seen in 42 (28%) patients with stroke mimic and 122 (62%) patients with stroke/transient ischemic attack ( p < 0.001). Patients with stroke mimic were more likely to have a normal Tmax pattern (volume = 0mL; adjusted OR: 2.2, 95% CI: 1.1–4.3, p = 0.02). When the Tmax pattern was abnormal, a higher proportion of patients with stroke mimic had Tmax patterns fully discordant with clinical symptoms than patients with stroke/transient ischemic attack (28/39 (71%) vs. 10/115 (9%), p < 0.001). Fully discordant Tmax abnormalities were strongly associated with stroke mimic (adjusted OR: 48.6, 95% CI: 7.0–336, p < 0.001), with a negative predictive value for identifying mimic of 91% (95% CI: 85–94%). Conclusion While one-quarter of patients with stroke mimic show Tmax abnormalities on automated RAPID computed tomography perfusion imaging, the majority of patterns were discordant with symptoms and vessel status. Normal or fully discordant Tmax abnormalities are were more common with stroke mimic and may inform stroke treatment decision making.

scholarly journals Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2480-2487
Author(s):  
Salvatore Rudilosso ◽  
Alejandro Rodríguez ◽  
Sergio Amaro ◽  
Víctor Obach ◽  
Arturo Renú ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Predictive Value ◽  
Brain Perfusion ◽  
Complete Recovery ◽  
Vascular Perfusion ◽  
Computed Tomography Perfusion ◽  
Stroke Mimic ◽  
Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

Use of computed tomography perfusion for acute stroke in routine clinical practice: Complex scenarios, mimics, and artifacts

2018 ◽  
Vol 13 (5) ◽  
pp. 469-472 ◽  
Author(s):  
Carlos Garcia-Esperon ◽  
Andrew Bivard ◽  
Christopher Levi ◽  
Mark Parsons
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Treatment Decision ◽  
Added Value ◽  
Stroke Treatment ◽  
Computed Tomography Perfusion ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Weighted Sequences ◽  
Perfusion Maps

Background Computed tomography perfusion is becoming widely accepted and used in acute stroke treatment. Computed tomography perfusion provides pathophysiological information needed in the acute decision making. Moreover, computed tomography perfusion shows excellent correlation with diffusion-weighted imaging and perfusion-weighted sequences to evaluate core and penumbra volumes. Multimodal computed tomography perfusion has practical advantages over magnetic resonance imaging, including availability, accessibility, and speed. Nevertheless, it bears some limitations, as the limited accuracy for small ischemic lesions or brainstem ischemia. Interpretation of the computed tomography perfusion maps can sometimes be difficult. The stroke neurologist faces complex or atypical cases of cerebral ischemia and stroke mimics, and needs to decide whether the “lesions” on computed tomography perfusion are real or artifact. Aims The purpose of this review is, based on clinical cases from a comprehensive stroke center, to describe the added value that computed tomography perfusion can provide to the stroke physician in the acute phase before a treatment decision is made.

scholarly journals Subclinical rhythmic electrographic discharge in adults: an atypical evolution

1995 ◽  
Vol 53 (2) ◽  
pp. 266-269 ◽  
Author(s):  
Délrio F. Silva ◽  
Edmar Zanoteli ◽  
Márcia Marques Lima ◽  
Renato Anghinah ◽  
José Geraldo C. Lima
Keyword(s):  
Computed Tomography ◽  
Cerebrospinal Fluid ◽  
Transient Ischemic Attack ◽  
Computed Tomography Scan ◽  
Ischemic Attack ◽  
Tomography Scan

The subclinical rhythmic electrographic discharge in adults (SREDA) has been rarely reported. We describe the case of a 71 year-old man with transient ischemic attack, whose EEG showed an atypical evolution of this uncommon pattern. The computed tomography scan and cerebrospinal fluid were normal. We are not aware of any other report in the literature with this atypical evolution of SREDA.

scholarly journals Perfusion Computed Tomography in Transient Ischemic Attack

2011 ◽  
Vol 68 (1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Sohal K. Patel ◽  
Jordan Samuels ◽  
Bethany McClenathan ◽  
Yousef Mohammad ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Transient Ischemic Attack ◽  
Perfusion Computed Tomography ◽  
Ischemic Attack

scholarly journals Imaging Diagnosis of Transient Ischemic Attack in Clinic and Traditional Chinese Medicine

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Qigu Yao ◽  
Lincheng Zhang ◽  
Jing Zhou ◽  
Min Li ◽  
Weifeng Jing ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Transient Ischemic Attack ◽  
Doppler Sonography ◽  
Clinical Symptoms ◽  
Transcranial Doppler Sonography ◽  
Imaging Modalities ◽  
Ischemic Attack ◽  
And Function ◽  
Ct And Mri

Neuroimaging plays a pivotal role in Transient Ischemic Attack (TIA). Generally, clinicians focus on the specific changes in morphology and function, but the diagnosis of TIA often depends on imaging evidence. Whereas Traditional Chinese Medicine (TCM) is concerned with the performance of clinical symptoms, they began to use imaging methods to diagnose TIA. CT and MRI are the recommended modality to diagnose TIA and image ischemic lesions. In addition, Transcranial Doppler sonography (TCD) and Digital Subtraction Angiography (DSA) are two acceptable alternatives for diagnosing TIA patients. This article elaborates the update of imaging modalities in clinic and the development of imaging modalities in TCM. Besides, multiple joint imaging technologies also will be evaluated whether enhanced diagnostic yields availably.

scholarly journals Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew M. Penn ◽  
Nicole S. Croteau ◽  
Kristine Votova ◽  
Colin Sedgwick ◽  
Robert F. Balshaw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Transient Ischemic Attack ◽  
Final Diagnosis ◽  
Conditional Inference ◽  
Minor Stroke ◽  
Logistic Regression Models ◽  
Stroke Mimics ◽  
Stroke Mimic ◽  
Ischemic Attack

Abstract Background Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. Methods A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. Results Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00–1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12–1.35) in those 60–79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89–1.07). Conclusions Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians’ suspicion of TIA/MS. Trial registration ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.

scholarly journals Clinical Characteristics of Transient Ischemic Attack Patients with Atrial Fibrillation: Analyses of a Multicenter Retrospective Study

2015 ◽  
Vol 5 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Yuka Hama ◽  
Toshiyuki Uehara ◽  
Tomoyuki Ohara ◽  
Kazumi Kimura ◽  
Yasushi Okada ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Clinical Symptoms ◽  
Multivariate Logistic Regression Analysis ◽  
Ischemic Lesion ◽  
Lesion Pattern ◽  
Disturbance Of Consciousness ◽  
Using Data ◽  
Ischemic Attack ◽  
Single Lesion

Background: Atrial fibrillation (AF) is an important risk factor for transient ischemic attack (TIA). However, little is known about the characteristics of TIA patients with AF. This study investigated the characteristics of such patients, using data from a retrospective, observational, multicenter study. Methods: TIA patients admitted to 13 stroke centers in Japan within 7 days of onset between January 2008 and December 2009 were included. The present analyses compared baseline characteristics, clinical symptoms, findings from diffusion-weighted imaging (DWI), and clinical outcomes between patients with and without AF (AF and non-AF groups). Results: A total of 464 patients (292 men; mean age 68.5 ± 13.2 years) were registered. Of these, 79 patients (17%) had AF. Patients in the AF group were older (73.9 ± 9.1 vs. 67.4 ± 13.6 years, p < 0.001) and more likely to show disturbance of consciousness (13 vs. 6%, p = 0.046) and aphasia (9 vs. 3%, p = 0.007) than patients in the non-AF group. Although no difference in the overall DWI-positive rate was seen between the groups (28 vs. 20%, p = 0.102), a single lesion (23 vs. 10%, p < 0.001), a lesion ≥15 mm (11 vs. 4%, p = 0.006), and a single lesion ≥15 mm (11 vs. 2%, p < 0.001) on DWI were more frequent in the AF group. Multivariate logistic regression analysis identified increased age [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.02-1.07] and DWI single lesion ≥15 mm (OR 5.67; 95% CI 1.92-16.7) as independently associated with the presence of AF. Conclusions: In this study, 17% of our TIA patients had AF. We found an association between the acute ischemic lesion pattern on DWI of a single lesion ≥15 mm and AF in TIA patients. These results might lead to a better diagnosis of TIA patients with AF.

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