Stroke Imaging and Complications Dr K Darawil Consultant Physician

1. Stroke Imaging and Complications Dr K Darawil Consultant Physician

2. Overview What do you know about • What to look for on a CT scan • Possible complications on the stroke unit • How to manage them

3. What to look for on a CT? • “Normal” CT – allows thrombolysis to be considered • Local parenchymal swelling • Focal low density in arterial distribution esp. insular ribbon and central grey matter (caudate/lentiform) • High attenuation vessel- dense artery sign K Darawil

4. Note normal higher density of deep grey nuclei K Darawil

5. Non specific small vessel changes K Darawil

6. Example of low density and parenchymal swelling K Darawil

7. Low density in white matter on CT – MRI (T2W) 24 hours later in acute stroke K Darawil

8. Low density due to cerebellar infarct K Darawil

9. Acute left weakness; increased density right MCA in sylvian fissure K Darawil

10. Low density left caudate and deep white matter K Darawil

11. Dense L MCA K Darawil

12. What to exclude? • Haemorrhage – in any compartment; generally hyperdense if acute blood • Mass lesions • Infection K Darawil

13. Acute mimic Sub arachnoid haemorrhage = Shows high density fresh blood K Darawil

14. Subacute stroke mimic Subdural haematoma – K Darawil

15. Easy things to miss! • Early stroke – remember about 75% are in MCA territory • Venous stroke • Basilar artery thrombosis • Stroke mimics • Dissection K Darawil

16. Dense basilar artery due to thrombosis K Darawil

17. Note mass effect due to meningioma with slight hyperdensity – stroke mimic K Darawil

18. Early after stroke Epileptic seizures Neurological deterioration Recurrence of stroke Haemorrhagic transformation Aspiration pneumonia Fever Arrhythmias After first few days Bladder/bowel Dehydration Venous thrombosis Pressure sores Spasticity & contractures Painful shoulder Low mood &anxiety emotionalism What to look for on the stroke unit? Post Stroke complications K Darawil

19. What to have in place? • Continuous physiological monitoring-72 hrs • Daily review & goals setting • Protocols for Swallow screen nutritional support Diabetes & BP continence (constipation) • Assessment by SLT • Early Physio & OT • Screen for depression, anxiety in first month • Carers to be trained & given support/equipment K Darawil

20. A case from the stroke unit • A 75 old lady admitted with a TACS. Her blood tests are all within normal limits apart from a blood sugar of 16. Admission BP 185/90.Her swallow is impaired. • Questions • Would you do something to control her blood glucose & BP? How? • What observation regime would you carry out? • How would you ensure adequate nutrition and hydration? K Darawil

21. A case from the stroke unit • 5 days after her admission you were told her blood pressure has suddenly dropped to 90/50. On examination, in addition to the hypotension you find her pulse is 80 and regular, but her temperature is 38.5°C. • Questions • List any abnormalities. • List 3 possible causes for hypotension after stroke. • What would you do in this case? K Darawil

22. What do you know about Overview • What to look for on a CT scan • Possible complications on the stroke unit • How to manage them K Darawil