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Radiology
Cerebrovascular Disease
Built from Fundamentals of Diagnostic Radiology
What’s inside
8 sections · 123 slides
Overview
- What this deck covers
Stroke Overview
What a stroke is, how it is classified, and why imaging drives care
- Two kinds of stroke
- Stroke and infarction defined
- Transient ischemic attack
- 3rd
- Why rapid imaging changes care
Ischemic Stroke: Etiology and Pathophysiology
Why infarcts happen and how ischemia becomes visible on imaging
- Where ischemic strokes come from
- Differential diagnosis of ischemic stroke by age
- Rarer but important causes
- Brain energy supply is fragile
- Which cells suffer first
- How ischemia changes the image
- Water changes drive the findings
- Hyperacute signs on CT and MR
- Acute MCA ischemia on CT
- Insular ribbon sign
Emergency Triage and Imaging Time Course
Choosing patients for reperfusion and reading the evolving infarct
- Triage for emergency intervention
- ASPECTS scoring
- CT stroke protocol
- Hyperdense artery sign and ASPECTS regions
- Multimodal CT stroke triage
- Malignant stroke pattern on CT
- Diffusion-weighted imaging
- Edema in stroke of unknown onset
- Diffusion-perfusion mismatch
- FLAIR in ischemia
- Subacute and chronic ischemia
- Fogging effect and gyral enhancement
- Chronic infarction
- Chronic infarction
- Hemorrhagic transformation of infarction
- Petechial gyral hemorrhage
- Petechial hemorrhage and gyral enhancement
- Gross hematoma transformation
- Contrast: CT triage
- CT enhancement of infarction
- MR contrast in stroke
- Intravascular stasis and enhancement
- Imaging time course after brain infarction
Pattern Recognition and Vascular Territories
Matching the imaging pattern to a known arterial territory
- Pattern recognition
- Glioblastoma mimicking a stroke
- Functional anatomy of the cortex
- Homunculus
- Internal carotid artery
- Carotid stenosis and screening
- Carotid disease: atherosclerosis and dissection
- Anterior cerebral artery
- MRA of the normal circle of Willis
- Anterior cerebral artery occlusion
- Hemorrhagic infarction in ACA distribution
- ACA stroke syndromes
- Middle cerebral artery
- MCA hemispheric branches
- Middle cerebral artery occlusion
- MCA stroke syndromes
- Functional vascular anatomy
- Vertebral arteries
- Vertebrobasilar arteries
- Basilar artery
- Acute brainstem infarction
- Posterior cerebral artery
- Posterior cerebral artery occlusion
- Posterior cerebral artery infarction
- Cerebellar arteries
- SCA, AICA, and PICA territories
- Vertebral dissection with PICA infarction
- Watershed infarction
- Watershed ischemia
- Watershed infarctions
Small Vessel and Venous Ischemia
Lacunes, perivascular spaces, vasculitis, and venous infarction
- Lacunes
- Old versus new lacunes
- Internal capsule lacunes
- Somatotopy of the internal capsule
- Lacunes versus perivascular spaces
- Virchow-Robin spaces
- Small vessel ischemic changes
- Small vessel ischemic changes
- Vasculitis and reversible vasoconstriction
- Venous infarction
- Venous infarct pattern
- Transverse sinus occlusion with venous infarction
- Venous sinus thrombosis
Hemorrhage
Detecting and dating blood, then finding its cause
- Hemorrhage overview
- MR signal of blood
- Hemoglobin oxidation sequence
- Biochemical evolution of hemorrhage
- Evolution of hemorrhage by MR
- Oxy- and deoxyhemoglobin
- Methemoglobin
- Hemosiderin
- Subarachnoid hemorrhage
- Berry aneurysms
- Common aneurysm sites
- Aneurysm presentations and treatment
- Ruptured anterior communicating artery aneurysm
- Endovascular coil treatment of basilar tip aneurysm
- Detecting subarachnoid hemorrhage
- Subtle subarachnoid hemorrhage by CT
- SAH workup and follow-up
- Parenchymal hemorrhage
- Hypertensive hemorrhage
- Spot sign and clot expansion
- Hypertensive hemorrhage and spot sign
- Acute parietal hematoma on MRI
- Vascular malformations
- Vascular malformation subtypes
- High-flow vascular malformations
- Arteriovenous malformations
- Low-flow malformations
- Low-flow vascular malformations
- Coagulopathy and drug hemorrhage
- Amyloid angiopathy
- Amyloid versus hypertensive microbleeds
- Hemorrhage versus hemorrhagic neoplasm
- Hemorrhagic metastases
- Benign versus malignant hemorrhage
Takeaways
The radiologist's checklist for stroke imaging
- Stroke imaging checklist
- Core ideas to remember
- Suggested readings
- Suggested readings (continued)
- Suggested readings (continued)
- Suggested readings (continued)
- Brant and Helms' Fundamentals of Diagnostic Radiology