Estimate age of stroke - MRI

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Age of stroke on MR (from Diagnostic Neuroradiology by Osborn)

Immediate

  • Absence of normal flow void
  • Intravascular contrast enhancement
  • Diffusion restriction (high DWI/low ADC)
  • Perfusion alteration
  • High DWI and normal T2/FLAIR is 62% sensitive and 78% specific for stroke <4.5hours old [Lancet Neurology 10/5/2011]

<12h

  • Sulcal effacement
  • Gyral edema
  • Loss of gray-white

12-24h

  • Hyperintensity on T2/FLAIR
  • Meningeal enhancement adjacent to infarct
  • Mass effect

1-3 days

  • Intravascular, meningeal enhancement starts to decrease
  • Early parenchymal enhancement
  • Striking signal abnormality on T1/T2
  • Hemorrhagic transformation may be evident

4-7 days

  • Striking parenchymal enhancement
  • Hemorrhage in 25%
  • Mass effect diminishing
  • Intravascular, meningeal enhancement disappears

1-8 weeks

  • Contrast enhancement often persists
  • Restricted diffusion ends at ~10-14 days
  • Mass effect resolves
  • Decrease in abnormal T2 signal sometimes
  • Hemorrhagic changes evolve

Months/Years

  • Encephalomalacic changes, volume loss
  • Hemosiderin staining if prior hemorrhage