Clinical application of brain perfusion imaging in detecting stroke mimics: A review. Issue 1 (7th October 2022)

• Record Type: Journal Article
• Authors: Khalili, Neda; Wang, Richard; Garg, Tushar; Ahmed, Amara; Hoseinyazdi, Meisam; Sair, Haris I.; Luna, Licia P.; Intrapiromkul, Jarunee; Deng, Francis; Yedavalli, Vivek
• Is Part Of: Journal of neuroimaging. Volume 33:Issue 1(2023)
• Page Start: 44
• Page End: 57
• Publication Date: 2022-10-07
• Subjects: acute ischemic stroke -- computed tomography -- magnetic resonance imaging -- perfusion imaging -- stroke mimic; Diagnostic imaging -- Periodicals; Nervous system -- Diseases -- Diagnosis -- Periodicals; Imagerie pour le diagnostic -- Périodiques; Système nerveux -- Maladies -- Diagnostic -- Périodiques; Imagerie médicale; Neuroimagerie; Neurologie; Système nerveux; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.804754
• DOI: 10.1111/jon.13061
• Languages: English
• ISSNs: 1051-2284

Abstract

Abstract: Stroke mimics constitute a significant proportion of patients with suspected acute ischemic stroke. These conditions may resemble acute ischemic stroke and demonstrate abnormalities on perfusion imaging sequences. The most common stroke mimics include seizure/epilepsy, migraine with aura, brain tumors, functional disorders, infectious encephalopathies, Wernicke's encephalopathy, and metabolic abnormalities. Brain perfusion imaging techniques, particularly computed tomography perfusion and magnetic resonance perfusion, are being widely used in routine clinical practice for treatment selection in patients presenting with large vessel occlusion. At the same time, the utilization of these imaging modalities enables the opportunity to better diagnose patients with stroke mimics in a time‐sensitive setting, leading to appropriate management, decision‐making, and resource allocation. In this review, we describe patterns of perfusion abnormalities that could discriminate patients with stroke mimics from those with acute ischemic stroke and provide specific case examples to illustrate these perfusion abnormalities. In addition, we discuss the challenges associated with interpretation of perfusion images in stroke‐related pathologies. In general, perfusion imaging can provide additional information in some cases—when used in combination with conventional magnetic resonance imaging and computed tomography—and might help in detecting stroke mimics among patients who present with acute onset focal neurological symptoms.