Estimate age of stroke - CT

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CT Stroke Aging(From Diagnostic Neuroradiology by Osborn)

Hyperacute (<12h)

  • Normal (50-60%)
  • Hyperdense artery (25-50%)
  • Obscuration of lentiform nuclei

Acute (12-24h)

  • Low density basal ganglia
  • Loss of gray-white interfaces (insular ribbon sign, obscuration of cortex-medullary white matter border)
  • Sulcal effacement

1-3days

  • Increasing mass effect
  • Wedge-shaped low density area that involves both gray and white matter
  • Hemorrhagic transformation may occur (most often basal ganglia and cortex)

4-7 days

  • Gyral enhancement
  • Mass effect, edema persist

1-8 weeks

  • Contrast enhancement perists
  • Mass effect resolves
  • Transient calcification can occur (pediatric strokes)

Months-years

  • Encephalomalacic change, volume loss
  • Calcification rare