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Imaging in stroke and vascular disease—part 1: ischaemic stroke
  1. Shelley Renowden
  1. Correspondence to Dr Shelley Renowden, Department of Neuroradiology, Frenchay Hospital, Bristol, UK; shelley.renowden{at}

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Stroke is the third leading cause of death in Europe, the USA, Canada and Japan, and is the primary cause of adult disability in these countries. Over 80% are ischaemic (cardiogenic, atherosclerotic, lacunar, haemodynamic and cryptogenic). The remainder are haemorrhagic (largely parenchymal and subarachnoid) and are considered in a separate article. Some pathologies may cause infarction and haemorrhage, for example, hypertensive vascular disease, moyamoya, vasculitis, reversible vasoconstriction syndrome, arterial dissection and venous occlusive disease.

Cranial CT is the most useful initial imaging modality to differentiate between ischaemia and haemorrhage, and to exclude stroke mimics.

Extra reading

Leiva-Salinas C, Wintermark M. Imaging of acute ischemic stroke. Neuroimaging Clin N Am 2010;20:455–68.

De Lucas EM, Sanchez E, Gutierrez A, et al. CT protocol for acute stroke: tips and tricks for general radiologists. Radiographics 2008;28:1673–87.

Barber PA, Demchuk AM, Zhang J, et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000;355:1670.

Pavlovic AM, Barras CD, Hand PJ, et al. Brain Imaging in transient ischaemic attack- redefining TIA. J Clin Neurosci 2010;17:1105–10.

Rodallec MH, Marteau V, Gerber S, et al. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics 2008;28:1711–28.

Touze E, Oppenheim C, Trystram D, et al. Fibromuscular dysplasia of cervical and intracranial arteries. Int J Stroke 2010;5:296–305.

Figure 1

Axial non-contrasted CT head scans (A–E) and a coronal CT angiogram reconstruction (F) in a 60-year-old man with a hyperacute ischaemic stroke. Note dense thrombus in the left terminal internal carotid and middle cerebral artery (MCA) and an MCA branch in the Sylvian fissure. The hyperdense MCA is 100% specific, …

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  • A separate version of this paper which includes much more detail is available on the Practical Neurology website. To see this paper please visit the journal online (

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Joanna Wardlaw, Edinburgh, UK.

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