Hyperacute ischemic stroke

Discussion:

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.

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