40 Questions
What is the contraindication for IV TPA thrombolysis?
Infarct of >1/3 of MCA territory
What is the primary purpose of using NCCT in acute stroke?
To exclude hemorrhage and alternative causes
What is the name of the scoring system used to assess the infarct volume on CT scan?
ASPECTS
What is the earliest sign of stroke on CT scan?
Hyperdense vessel
What is the time window for mechanical thrombectomy in the UK guidelines?
Within 6 hours
What is the normal ASPECTS score in a healthy brain?
10
What type of edema is associated with stroke, in addition to vasogenic edema?
Cytotoxic edema
What is the main advantage of MRI over CT scans in diagnosing brain infarction?
Clear superiority for diagnosis of brain infarction, with equal sensitivity for infarcts regardless of location
What is the primary utility of CTA/perfusion in stroke imaging?
Assessing supratentorial circulation
What sequence is used to demonstrate multiple foci of high signal consistent with ischemic lesions?
Fluid-attenuated inversion recovery (FLAIR)
What is the term for the phenomenon where thrombus is not visible due to dispersion?
Thrombus dispersion
What is the name of the sign that is often seen in M2 branch of the middle cerebral artery?
Sylvian fissure dot sign
What is the term for the phenomenon where the margins of the lentiform nucleus and insular cortex become indistinct in early MCA stroke?
Loss of conscpicuity of cortex
What is the name of the MRI sequence that is particularly sensitive to the presence of deoxyhemoglobin in acute thrombus?
Susceptibility-weighted imaging (SWI)
What is the time period during which CT has a low sensitivity for acute stroke?
Within 3 hours
In what percentage of cases is a causative sinus thrombosis likely to be missed on CT scan?
40%
What is the characteristic MRI signal of acute blood products in a patient with cerebral venous thrombosis?
Low T1 and low T2 signal
What is the primary advantage of MRI over CT scan in the diagnosis of cerebral venous thrombosis?
Better detection of small thrombosis
What is the characteristic CT scan feature of a thrombosed vessel in a patient with cerebral venous thrombosis?
Hyperdense and expanded serpiginous structure with hypodense center
What is the primary complication of untreated cerebral venous thrombosis?
Venous hypertension and venous infarction
Which of the following is a characteristic of watershed infarcts on imaging?
Symmetric ischemia of grey matter
What is the primary site of infarction in small vessel strokes due to hypertension and diabetes?
Lentiform nucleus and internal capsule
What is the mechanism of borderzone infarction?
Local hypoperfusion or global hypoperfusion
What is the characteristic distribution of ischemia in borderzone infarction?
Linear distribution of ischemia in the cortical-subcortical junction
What is the typical pattern of ischemia in profound ischemia / deep ischemia?
Symmetric ischemia of grey matter
Which of the following MRI sequences is particularly sensitive to the presence of methemoglobin in subacute thrombus?
SWI
What is the characteristic MRI finding in subacute thrombus?
High T1 and high T2 signal
What is the most common parenchymal complication of superior sagittal sinus thrombosis?
Bilateral cortical and subcortical lesions
What is the characteristic feature of cerebral venous infarcts on MRI DWI?
Mixture of restricted and free diffusion
What is the typical location of parenchymal lesions in internal cerebral vein thrombosis or straight sinus thrombosis?
Bilateral basal ganglia lesions
What is the characteristic feature of vein of Labbé thrombosis or transverse venous sinus thrombosis on MRI?
Inferior parietal lobule and temporal lobe lesions
What is the typical location of parenchymal lesions in vein of Galen thrombosis?
Bilateral thalamic lesions
What is the characteristic feature of subacute thrombus on MRI SWI/on gradient echo?
Low signal
What is the percentage of children with SVT who will have venous infarct?
40%
What is the characteristic CT finding in early parenchymal complications of SVT?
Hypodense lesions
What is the primary indication for using CT scans in the evaluation of epidural hematoma?
Precise evaluation of implant position and alignment
What is the characteristic signal intensity of an acute epidural hematoma on T1-weighted MRI sequences?
Iso- or hypointense
What is the typical appearance of an epidural mass on T2-weighted MRI sequences?
Heterogeneous hyperintensity
What is the characteristic feature of CSF leakage syndrome?
Dural thickening and enhancement
What is the typical enhancement pattern of an epidural hematoma following gadolinium administration?
No enhancement
Identify the signs and symptoms of Middle Cerebral Artery (MCA) stroke on imaging studies. Learn to recognize the characteristics of MCA thrombus, parenchymal signs, and brain swelling on MRI and CT scans.
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