Imaging of Vascular Aphasia

Brain imaging is essential for the diagnosis of acute stroke and vascular aphasia. Magnetic resonance imaging (MRI) is the modality of choice for the etiological diagnosis of aphasia, the assessment of its severity, and the prediction of recovery. Diffusion weighted imaging is used to detect, localize, and quantify the extension of the irreversibly injured brain tissue called ischemic core. Perfusion weighted imaging (from MRI or CT) is useful to assess the extension of hypoperfused but salvageable tissue called penumbra. Functional imaging (positron emission tomography (PET), functional MRI (fMRI)) may help predicting recovery and is useful for the understanding of language networks and individual variability. This chapter is meant to review the state of the art of morphological and functional imaging of vascular aphasia and to illustrate the MRI profiles of different aphasic syndromes.

Mechanical Thrombectomy Up to 24 Hours in Large Vessel Occlusions and Infarct Velocity Assessment

Background We retrospectively compared early‐ (<6 hours) versus late‐ (6–24 hours) presenting patients using perfusion‐weighted imaging selection and evaluated clinical/radiographic outcomes. Methods and Results Large vessel occlusion patients treated with mechanical thrombectomy from August 2017 to July 2020 within 24 hours of onset were retrieved from a single‐center database. Perfusion‐weighted imaging was analyzed by automated software and final infarct volume was measured semi‐automatically within 14 days. The primary end point was good outcome (modified Rankin Scale 0–2 at 90 days). Secondary end points were excellent outcome (modified Rankin Scale 0–1 at 90 days), symptomatic intracranial hemorrhage, and death. Clinical characteristics/radiological values including hypoperfusion volume and infarct growth velocity (baseline volume/onset‐to‐image time) were compared between the groups. Of 1294 patients, 118 patients were included. The median age was 74 years, baseline National Institutes of Health Stroke Scale score was 14, and core volume was 13 mL. The late‐presenting group had more female patients (67% versus 31%, respectively; P =0.001). No statistically significant differences were seen in good outcome (42% versus 53%, respectively; P =0.30), excellent outcome (26% versus 32%, respectively; P =0.51), symptomatic intracranial hemorrhage (6.5% versus 4.6%, respectively; P =0.74), and death (3.2% versus 5.7%, respectively; P =0.58) between the groups. The late‐presenting group had more atherothrombotic cerebral infarction (19% versus 6%, respectively; P =0.03), smaller hypoperfusion volume (median: 77 versus 133 mL, respectively; P =0.04), and slower infarct growth velocity (median: 0.6 versus 5.1 mL/h, respectively; P =0.03). Conclusions Patients with early‐ and late‐time windows treated with mechanical thrombectomy by automated perfusion‐weighted imaging selection have similar outcomes, comparable with those in randomized trials, but different in infarct growth velocities. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02251665.

Favorable Outcome in a Case of Von Balo’s Sclerosis Mimicking a Juvenile Stroke at the Onset A New Possible Role of Dynamic Susceptibility Contrast (Dsc) Perfusion-Weighted Imaging (PWI).

We describe a juvenile stroke-like onset of Von Balò’s sclerosis, with a favorable outcome after 4 years of follow up, even if treatment’s protocols could not have been completed, because her low compliance. Following the patient with annual MRI imaging we surprisingly discovered associations between which was reported at a Perfusion-weighted Imaging (PWI) Dynamic susceptibility contrast (DSC)-MRI executed after 9 days from the exordium and patient’s clinical residues. By describing the case we focus on a new way to use PWI-DSC in order not only to determine areas of Blood-Brain-Barrier active lesion but also to have information on patients’ prognosis and to guide neurologist in his therapeutical choices. PWI can’t substitute other MRI sequences, which describe, in that moment of execution, how many cerebral areas are involved in the process of demyelization, but PWI, surely, is an excellent sequence to integrate diagnosis and improve patients’ clinical, diagnostic and therapeutic follow up.