Imaging

Embolic Stroke

Preliminary Diagnosis: Embolic Stroke

I. What imaging technique is first-line for this diagnosis?

CT of the brain without contrast. Contrasted CT brain may be performed in suspected septic emboli. Follow up CTA of the head and neck may be performed.

II. Describe the advantages and disadvantages of this technique for diagnosing embolic stroke.

Advantages

  • Relatively inexpensive, fast imaging modality.

  • Can detail intracranial hemorrhage with exquisite detail.

  • Less sensitive and specific to focal ischemia or infarction compared to MR imaging with diffusion weighted sequences.

Disadvantages

  • Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

Non-contrasted MR imaging of the brain with diffusion weighted imaging and gradient echo imaging sequences. Contrasted MR may be performed in the setting of suspected septic emboli. MRA of the head and neck may be performed as a follow up. TEE may be performed to evaluate a potential cardiac embolic source.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing embolic stroke.

Advantages

  • Highly specific and sensitive in detailing ischemia and infarction.

  • May detail the chronicity of blood product.

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

VI. What are the contraindications for the alternative imaging techniques?

Contraindicated in patients with non-MR compatible hardware.

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