eMedicine Specialties > Neurology > Neuro-imaging

Magnetic Resonance Imaging in Acute Stroke: Follow-up

Author: Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Contributor Information and Disclosures

Updated: Jul 15, 2009

Follow-up

Further Inpatient Care

Inpatients may often continue to be monitored and receive treatment while undergoing MRI because MRI-compatible ECG monitors, intravenous infusion pumps, and ventilators are available.

Inpatient & Outpatient Medications

A mild sedative may be ordered for patients with a history of claustrophobia. As an alternative, an open MRI may be ordered at the cost of lesser quality MR images.

Complications

  • Patients with metallic implants may have a variety of potential complications, such as heating and pacemaker malfunction and its consequences. For patients with a metallic implant, checking with the manufacturer regarding its MR compatibility is advisable if such information is not available elsewhere.
  • Claustrophobic patients may be unable to complete the sequence of MRI. In selected patients, mild sedation or imaging in an open MR system may be attempted. However, most open MR scanners provide lesser quality images.
  • Rarely, patients may be allergic to the contrast agent (eg, gadolinium) used in MRI.

Patient Education

For excellent patient education resources, visit eMedicine's Imaging Center and Stroke Center. Also, see eMedicine's patient education articles Magnetic Resonance Imaging (MRI) and Stroke.

Miscellaneous

Special Concerns

  • Patients who have received recent thrombolysis or are critically ill from stroke are probably not well suited for MRI because they cannot be monitored by clinical examinations during the period of imaging. If MRI is essential, it should be performed with the bare minimum of sequences required to make the diagnosis, such as T1, T2, DWI or PWI, and MRA. Many institutions have established acute stroke protocols to minimize scanning time.
  • Patients with acute stroke who are considered for MRI should be evaluated for contraindications to MRI such as claustrophobia, metallic implants, pacemakers, and MR-incompatible prosthetic heart valves.
 


More on Magnetic Resonance Imaging in Acute Stroke

Overview: Magnetic Resonance Imaging in Acute Stroke
Differential Diagnoses & Workup: Magnetic Resonance Imaging in Acute Stroke
Follow-up: Magnetic Resonance Imaging in Acute Stroke
Multimedia: Magnetic Resonance Imaging in Acute Stroke
References
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References

  1. Davis SM, Donnan GA, Butcher KS, Parsons M. Selection of thrombolytic therapy beyond 3 h using magnetic resonance imaging. Curr Opin Neurol. Feb 2005;18(1):47-52. [Medline].

  2. Hacke W, Furlan AJ, Al-Rawi Y, Davalos A, Fiebach JB, Gruber F. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol. Dec 17 2008;[Medline].

  3. Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol. Apr 2008;7(4):299-309. [Medline].

  4. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. Sep 25 2008;359(13):1317-29. [Medline].

  5. Hermier M, Nighoghossian N. Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke. Aug 2004;35(8):1989-94. [Medline].

  6. Baird AE, Warach S. Magnetic resonance imaging of acute stroke. J Cereb Blood Flow Metab. Jun 1998;18(6):583-609. [Medline].

  7. Blatter DD, Parker DL, Ahn SS, et al. Cerebral MR angiography with multiple overlapping thin slab acquisition. Part II. Early clinical experience. Radiology. May 1992;183(2):379-89. [Medline].

  8. Chalela JA, Haymore JB, Ezzeddine MA, et al. The hypointense MCA sign. Neurology. May 28 2002;58(10):1470. [Medline].

  9. Duong TQ, Fisher M. Applications of diffusion/perfusion magnetic resonance imaging in experimental and clinical aspects of stroke. Curr Atheroscler Rep. Jul 2004;6(4):267-73. [Medline].

  10. Fisher M, Albers GW. Applications of diffusion-perfusion magnetic resonance imaging in acute ischemic stroke. Neurology. Jun 10 1999;52(9):1750-6. [Medline].

  11. Geisler BS, Brandhoff F, Fiehler J, et al. Blood-oxygen-level-dependent MRI allows metabolic description of tissue at risk in acute stroke patients. Stroke. Jul 2006;37(7):1778-84. [Medline].

  12. Kidwell CS, Alger JR, Di Salle F, et al. Diffusion MRI in patients with transient ischemic attacks. Stroke. Jun 1999;30(6):1174-80. [Medline].

  13. Kidwell CS, Saver JL, Villablanca JP, et al. Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke. Jan 2002;33(1):95-8. [Medline].

  14. Medlock MD, Olivero WC, Hanigan WC, et al. Children with cerebral venous thrombosis diagnosed with magnetic resonance imaging and magnetic resonance angiography. Neurosurgery. Nov 1992;31(5):870-6; discussion 876. [Medline].

  15. Mok V, Chang C, Wong A, et al. Neuroimaging determinants of cognitive performances in stroke associated with small vessel disease. J Neuroimaging. Apr 2005;15(2):129-37. [Medline].

  16. Moseley ME, Cohen Y, Mintorovitch J, et al. Early detection of regional cerebral ischemia in cats: comparison of diffusion- and T2-weighted MRI and spectroscopy. Magn Reson Med. May 1990;14(2):330-46. [Medline].

  17. Moseley ME, Kucharczyk J, Mintorovitch J, et al. Diffusion-weighted MR imaging of acute stroke: correlation with T2-weighted and magnetic susceptibility-enhanced MR imaging in cats. AJNR Am J Neuroradiol. May 1990;11(3):423-9. [Medline].

  18. Rincon F. Anticoagulation and thrombolysis for acute ischemic stroke and the role of diagnostic magnetic resonance imaging. Arch Neurol. May 2004;61(5):801-2; author reply 802. [Medline].

  19. Runge VM, Kirsch JE, Wells JW, Woolfolk CE. Assessment of cerebral perfusion by first-pass, dynamic, contrast-enhanced, steady-state free-precession MR imaging: an animal study. AJR Am J Roentgenol. Mar 1993;160(3):593-600. [Medline].

  20. Schlaug G, Benfield A, Baird AE, et al. The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology. Oct 22 1999;53(7):1528-37. [Medline].

  21. Thurnher MM, Castillo M. Imaging in acute stroke. Eur Radiol. Mar 2005;15(3):408-15. [Medline].

  22. Yuh WT, Crain MR, Loes DJ, et al. MR imaging of cerebral ischemia: findings in the first 24 hours. AJNR Am J Neuroradiol. Jul-Aug 1991;12(4):621-9. [Medline].

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Further Reading

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Keywords

cerebrovascular accident, CVA, acute ischemic stroke, cerebrovascular disease, T1-weighted imaging, T2-weighted imaging, spin density–weighted imaging, gradient echo imaging, diffusion-weighted imaging, perfusion-weighted imaging, MRI, MRI in acute stroke

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Contributor Information and Disclosures

Author

Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Souvik Sen, MD, MS, FAHA, is a member of the following medical societies: American Academy of Neurology, American Heart Association, and Association for Patient Oriented Research
Disclosure: Nothing to disclose.

Medical Editor

Draga Jichici, MD, FRCP, Associate Clinical Professor, Department of Medicine, Division of Neurology and Critical Care Medicine, McMaster University, Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

 
 
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