Andrew Xavier | PubMed Health

PubMed2004

Advanced imaging application for acute ischemic stroke.

With the approval of intravenous recombinant tissue plasminogen activator (r-TPA) in 1995, acute ischemic stroke therapy is increasingly being administered. Currently the approach to imaging these patients is very simplistic. Typically, noncontrast head computed tomography (CT) is the only study performed prior to treatment. Advanced imaging using CT or magnetic resonance imaging (MRI) can play a very important role in the triage and classification of patients with acute ischemic stroke. With knowledge of the location and size of the occlusion as well as the collateral circulation, the best treatment can be selected, minimizing any morbidity from treatment and maximizing the chance of success. The identification and stratification of patients according to their imaging and clinical features will further individualize treatment and allow tailored therapy. This review will discuss rapid imaging techniques that are easily available and the rationale for their use.

Animals↗

PubMed2004

Treatable potential cardiac sources of embolism in patients with cerebral ischemic events: a selective transesophageal echocardiographic study.

OBJECTIVES: To characterize cardiac sources of emboli detected by transesophageal echocardiography (TEE) in patients without recognizable cause of transient ischemic attack (TIA) and/or ischemic stroke and TIA. METHODS: We examined a prospective registry that included all patients with TIA and/or stroke evaluated by TEE between July 2000 and August 2001 at our medical center. Ischemic events were classified according to clinical and neuroimaging findings as cortical, lacunar, or vertebrobasilar circulation. Demographic, clinical, neuroimaging, and echocardiographic characteristics were studied. RESULTS: TEE was performed in 237 patients without recognized cause of TIA and/or stroke, of which 105 (44%) events were cortical, 35 (15%) were lacunar, 32 (14%) were vertebrobasilar, and 65 (27%) were in multiple distributions. Mean age of patients was 59 +/- 14 years (range, 21 to 93 years); 119 (51%) were men. Potential treatable cardioembolic sources were detected in 146 (61%) patients: patent foramen ovale with right-to-left shunt (n = 59), left atrial clot (n = 6), left atrial appendage clot (n = 8), and severe thoracic aortic atherosclerotic plaque disease (plaque thickness >4 mm) (n = 79 patients [33%], 56 had an ulcerated plaque and 4 had mobile plaque). Patient age and topography of the ischemic event did not correlate with TEE-defined cardioembolic sources. CONCLUSIONS: TEE identified high frequencies of potential treatable cardioembolic sources in patients with ischemic events. TEE should be considered in all patients who do not have identified cause of TIA and/or stroke for early treatment and prevention of recurrent events.

Adult↗