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Congress: ECR25
Poster Number: C-27399
Type: Poster: EPOS Radiologist (educational)
Authorblock: A. Zurashvili, E. Tserodze; Tbilisi/GE
Disclosures:
Ana Zurashvili: Nothing to disclose
Elene Tserodze: Nothing to disclose
Keywords: Neuroradiology brain, CT-Angiography, MR, MR-Diffusion/Perfusion, Contrast agent-intravenous, Acute
Learning objectives Underline the clinical importance of differentiating between actual stroke and stroke mimics in acute settings Outline the specific characteristic imaging findings of common stroke mimics to improve diagnostic accuracy,  Highlight the role of diffusion weighted imaging (DWI). Apply the knowledge of DWI patterns to refine clinical understanding of stroke mimics and decrease the risk of misdiagnosis and proper treatment
Read more Background Stroke is a medical emergency and presents with focal neurological deficits. Immediate evaluation, confirmation  of diagnosis and treatment to re-establish blood flow leads to improvement in symptoms and prevention of brain damage. The diagnosis of acute ischaemic stroke is however not always straightforward. Similar symptoms may develop in a number of medical conditions commonly referred to as “stroke mimics’’.  Stroke mimics (SM) are non-vascular conditions that present with  an acute neurological deficit simulating acute ischemic stroke and represent a significant...
Read more Findings and procedure details Commonly encountered stroke mimics Seizure — May mimic in  both ictal and post ictal presentations  DWI: Restricted diffusion predominantly in the cortical grey matter with sparing of subcortical white matter. Perfusion Imaging: Increased perfusion in affected regions, differentiating it from ischemia. FLAIR: Gyral hyperintensity due to cortical edema. Contrast-Enhanced MRI: Gyral enhancement in later stages. Migraine — Aura can mimic stroke DWI: No diffusion restriction (key feature to exclude stroke). T2/FLAIR: Transient hyperintensities in the cortex or subcortical white matter, particularly in the centrum semiovale or brainstem. Perfusion Imaging:...
Read more Conclusion Stroke mimics are common in the emergency department and some of these patients may be treated with intravenous tPA. Despite many clinical and imaging overlaps, a pattern-based approach provides a reasonably accurate method to diagnose of many of these conditions and facilitate appropriate and timely management. Not everything that restricts is a stroke.
Read more References https://appliedradiology.com/articles/stroke-differential-diagnosis-and-mimics-part-1 https://radiopaedia.org/articles/hypoglycaemia?lang=us https://pubmed.ncbi.nlm.nih.gov/28551302/ https://radiopaedia.org/articles/diffusion-weighted-imaging-in-acute-ischaemic-stroke ESSENTIALS OF OSBORN’S BRAIN: A FUNDAMENTAL GUIDE  FOR RESIDENTS AND FELLOWS   Core radiology   
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