A 68-year-old woman is brought to the emergency department 45 minutes after the sudden onset of left-sided weakness and slurred speech. The clinical team initiates the acute stroke protocol. Arrange the following imaging modalities in the chronological order their results must be interpreted to rapidly diagnose the condition, determine eligibility for reperfusion therapies, and ultimately confirm the extent of the injury.
- 1Non-contrast computed tomography (CT) of the head
- 2Computed tomography angiography (CTA) of the head and neck
- 3Magnetic resonance imaging (MRI) of the brain with diffusion-weighted imaging
Cevap
The correct interpretation sequence is: Non-contrast CT of the head, followed by CTA of the head and neck, and finally MRI of the brain.
In acute stroke evaluation, non-contrast CT is interpreted first because it rapidly and accurately excludes intracranial hemorrhage, allowing for the timely administration of thrombolytics. This is immediately followed by the interpretation of a CTA to evaluate for large vessel occlusion, which would necessitate mechanical thrombectomy. MRI is the most sensitive test for interpreting ischemic stroke extent but is reserved for later definitive evaluation due to its longer acquisition time and more limited emergent availability.
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Anahtar Kavram
In the acute management of stroke, imaging interpretation must sequentially rule out hemorrhage (non-contrast CT), identify targetable vascular lesions (CTA), and definitively characterize the infarct (MRI).