iPhone and Stroke

"Doctors can make a stroke diagnosis using an iPhone application with the same accuracy as if they use a medical computer workstation. According to researchers  this can be particularly useful in rural medical settings."

Reference and Further reading- Healthcare IT News

Suspected Artery of Percheron Infarct-Rare Case Report

Thalami and midbrain arterial supply arises from many perforating blood vessels with a complex distribution for which many variations have been described. One rare variation, named the “artery of Percheron,” is a solitary arterial trunk that arises from one of the proximal
segments of a posterior cerebral artery and supplies the paramedian thalami and the rostral midbrain bilaterally. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions. This is a 50 year old female who developed sudden altered sensorium following hypotension due to sorbitrate administration. Similar cases have been described in AJNR Am J Neuroradiol 24:2005–2008, November/December 2003. Diffusion and FLAIR images of the case have been provided showing FLAIR hyperintensity and differential bright signal on DWI.

Case Submitted by Dr Sangeeta Aneja, MD, Associate Professor & Head, Department of Radiodiagnosis, L.L.R.M. Medical College, Meerut.

Early Stroke-CT finding

NCCT done on the day reveals obscuration of the outline of lentiform nucleus, which is a early sign of infarction. CT repeated next day confirms the right MCA territiry infarct.

Hyperdense MCA sign-Hyperacute Stroke

Axial CT images demonstrate increased linear attenuation within the left middle cerebral artery. Hyperacute stroke was suspected. MRI was done and diffusion weighted MRI confirms left MCA territory infarct.

Coronal Diffusion Weighted Imaging

Coronal DW-EPI can more easily demarcate ischemia in the brainstem and/or cerebellum than axial scans when susceptibility artifacts are present as in this case wherein axial DW scan was read as equivocal while coronal DWI confirms the acute infarction. Coronal scans also demonstrate the site and direction of the pyramidal tract and its anatomical correlation with the lesions.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology Director,

DAMS (Delhi Academy of Medical Sciences)

Anterior Cerebral Artery Infarct

These are diffusion weighted MRI images of ACA territory relativel fresh infarct. Acute infarct shows differential bright signal on DWI.

Ischemic Stroke-MRI

This is diffusion weighted image showing left MCA territory acute infarct. MRA brain done at the time shows left MCA block with diffuse atherosclerotic changes.

MRI better than CT for initial evaluation of stroke

"A multicenter prospective trial involving 1210 patients in Europe has found that the odds of a favorable clinical outcome were one-third higher for acute stroke patients who received diffusion-perfusion MRI to determine the appropriateness of tPA thrombolysis than patients assessed with conventional noncontrast CT. Results drawn from the Safe Implementation of Thrombolysis in Stroke trial were presented at International Stroke Conference in San Francisco."

Report from International Stroke Conference: MRI outperforms CT for initial stroke evaluation

Reference

Diagnostic Imaging Online