Significant reductions in length of stay after carotid endarterectomy can be safely accomplished without modifying either anesthetic technique or postoperative ICU monitoring
Pd. Angevine et al., Significant reductions in length of stay after carotid endarterectomy can be safely accomplished without modifying either anesthetic technique or postoperative ICU monitoring, STROKE, 30(11), 1999, pp. 2341-2346
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.