Brain Imaging May Expand Stroke Treatment

Using MRI to look at the brains of people who’ve had a stroke but who can’t tell when the stroke began might help identify those who could safely be treated. Approximately 25% of ischemic strokes occur in people who don’t know, or are unable to communicate, when their stroke began. That usually makes them ineligible for thrombolytic therapy, which must be given within 4.5 hours of the onset of stroke symptoms, according to treatment guidelines.

A preliminary study of 430 patients with unclear-onset stroke used MRI to select 19 patients who were thought to be within that treatment window, Dr. Dong-Wha Kang of the University of Usan, Seoul, South Korea reported at the International Stroke Conference. Treating those 19 resulted in a good clinical outcome in 37 (45%), which Dr. Kang said is encouraging enough to justify further studies of this approach.

He showed three examples of MRIs to illustrate how they selected patients for treatment. The first image shows no mismatch between brain lesions viewed on diffusion-weighted imaging (DWI) or fluid-attenuated inversion-recovery (FLAIR) MRI. This patient was considered a poor candidate for treatment and was not enrolled in the study.

The second image shows a partial FLAIR change within the DWI lesion and a perfusion-diffusion mismatch. This patient was eligible for treatment.

All images courtesy Dr. Dong-Wha Kang.

The third image shows a large perfusion-diffusion mismatch and no FLAIR changes within the DWI lesion, making this a good candidate for treatment in the study.

Everyone agrees the study wasn’t strong enough to change clinical practice, and reasons for wanting further studies differed. Some were encouraged and want more studies to see if this approach pans out. Others were skeptical and want more studies to prove that there’s really something of value here besides pretty images.

Hear Dr. Mark Alberts, professor of neurology and director of the stroke program at Northwestern University, commenting on the study in a  minute-and-a-half podcast  provided by the American Heart Association and the American Stroke Association (sponsors of the conference).

And learn more from my full story and video.

— Sherry Boschert (@sherryboschert on Twitter)


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Filed under Emergency Medicine, Family Medicine, Geriatric Medicine, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Neurology and Neurological Surgery, Polls

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