Hyperacute ischemic stroke
Known case of severe hypertension with sudden onset right hemiplegia
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There is an extensive area of high signal intensity on DWI and low signal on ADC in the left cerebral hemisphere involving the cortical grey and deep white matter of the frontoparietal lobes and the basal ganglia representing the middle cerebral artery territory. T1W showed isointense signal with obliteration of the Sylvian fissure due to edema, there is subtle increased signal intensity on T2/FLAIR, no evidence of hemorrhagic changes is noted on GRE.
The right cerebral parenchyma shows focal areas of chronic infarction in the deep white matter involving the corona radiata and centrum semiovale.
Strokes may be classified and dated thus: early hyperacute, a stroke that is 0–6 hours old; late hyperacute, a stroke that is 6–24 hours old; acute, 24 hours to 7 days; subacute, 1–3 weeks; and chronic, more than 3 weeks old.
MRI features of hyperacute ischemic stroke are classically depicted in this patient. Low signal intensity on ADC, hyperintensity on DWI, high signal on T2/FLAIR and isointense signal on T1W sequences are findings pointing to hyperacute ischemic stroke. T1+Contrast (not given in this patient) may show arterial enhancement after 2 hours and parenchymal enhancement may occur after 2-4 hours in incomplete infarction. GRE is unlikely to show hemorrhagic transformation within 12 hours.
Accurate timing of stroke is important in patients with ischemic stroke in order to identify those who will benefit from thrombolytic and neurointerventional therapies.
- Laura M. Allen, Anton N. Hasso, Jason Handwerker, Hamed Farid. Sequence-specific MR Imaging Findings That Are Useful in Dating Ischemic Stroke. (2012) RadioGraphics. 32 (5): 1285-97;