Significant reductions in length of stay after carotid endarterectomy can be safely accomplished without modifying either anesthetic technique or postoperative ICU monitoring

Background and Purpose-MRI has been increasingly used in the evaluation of acute stroke patients. However, MRI must be able to detect early hemorrhage to be the only imaging screen used before treatment such as thrombolysis, Susceptibility-weighted imaging, an echo-planar T2* sequence, can show intr acerebral hemorrhage (ICH) in patients imaged between 2.5 and 5 hours from symptom onset. It is unknown whether MRI can detect ICH earlier than 2.5 ho urs. We describe 5 patients with ICH who had MRI between 23 and 120 minutes from symptom onset and propose diagnostic patterns of evolution of hyperac ute ICH on MRI. Methods-As part of our acute imaging protocol, all patients with acute stro ke within 24 hours from symptom onset were imaged with a set of sequences t hat included susceptibility-weighted imaging, diffusion- and perfusion-weig hted imaging, T1- and T2-weighted imaging, fluid-attenuated inversion recov ery (FLAIR), and MR angiography using echo-planar techniques. Five patients with ICH had MRI between 23 and 120 minutes from the onset of symptoms. Results-ICH was identified in all patients. Distinctive patterns of hyperac ute ICH and absence of signs of ischemic stroke were the hallmark features of this diagnosis. The hyperacute hematoma appears to be composed of 3 dist inct areas: (1) center: isointense to hyperintense heterogeneous signal on susceptibility-weighted and T2-weighted imaging; (2) periphery: hypointense (susceptibility effect) on susceptibility-weighted and T2-weighted imaging ; and (3) rim: hypointense on T1-weighted imaging and hyperintense on T2-we ighted imaging, representing vasogenic edema encasing the hematoma, Conclusions-MRI is able to detect hyperacute ICH and show a pattern of evol ution of the hematoma within 2 hours from the onset of symptoms.