Document Detail


Time is brain: is MRI the clock?
MedLine Citation:
PMID:  17620875     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: MRI is increasingly used as the primary imaging modality in acute stroke, since it allows treatment based on individual pathophysiology rather than strict time windows.
RECENT FINDINGS: PET studies have confirmed that regions with disturbed diffusion frequently indicate irreversible tissue damage, although they may in part be viable. The mismatch between a larger perfusion deficit and a smaller diffusion abnormality contains both critically hypoperfused regions as well as oligemic regions. Although mismatch is thus not perfect, recent prospective trials have convincingly shown that mismatch patients treated with revascularization therapies benefit from reperfusion, while patients without mismatch do not. This is particularly important for patients presenting beyond the first three hours. In addition, several studies have investigated MRI as a tool to assess the risk of thrombolytic treatment. Parameters reflecting severe ischemia, blood-brain barrier damage and preexisting small-vessel disease emerge as risk factors for intracerebral hemorrhage, while microbleeds are not clearly associated with an increased risk.
SUMMARY: Based on data from prospective trials, the mismatch concept is an acceptable method to identify patients who benefit from recanalization therapies. The concept, however, still needs to be further improved and standard definitions are required before widespread use can be recommended.
Authors:
Tobias Neumann-Haefelin; Helmuth Steinmetz
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in neurology     Volume:  20     ISSN:  1350-7540     ISO Abbreviation:  Curr. Opin. Neurol.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-10     Completed Date:  2007-12-27     Revised Date:  2013-01-18    
Medline Journal Info:
Nlm Unique ID:  9319162     Medline TA:  Curr Opin Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  410-6     Citation Subset:  IM    
Affiliation:
Department of Neurology, Goethe-University Frankfurt, Frankfurt, Germany. tnh@rz.uni-frankfurt.de
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MeSH Terms
Descriptor/Qualifier:
Blood-Brain Barrier / pathology,  physiopathology
Brain Ischemia
Cerebral Hemorrhage / etiology
Diffusion
Humans
Leukoaraiosis / pathology
Magnetic Resonance Imaging* / utilization
Perfusion
Positron-Emission Tomography
Prospective Studies
Risk Factors
Stroke* / diagnosis,  pathology
Thrombolytic Therapy / adverse effects
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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