Training Collections
Library Memberships
Black Friday Save 30%On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Black Friday Save 30%Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Black Friday Save 40%Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
BLACK FRIDAY SAVE 30%Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
Black Friday Save 30%On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Black Friday Save 30%Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Black Friday Save 40%Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
BLACK FRIDAY SAVE 30%Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Lesson
Pre-Course Activities
1 topic, 3 min.
Lesson
Introduction to Stroke Imaging
4 topics, 17 min.
Lesson
Noncontrast CT
5 topics, 14 min.
Lesson
CTA Neck
10 topics, 33 min.
Vascular Imaging in Stroke - CTA vs MRA
2 m.Carotid and Vertebral Vasculopathies Overview & Examples of Atherosclerotic Disease
3 m.Case - Atheromatous Disease with Severe ICA Stenosis
4 m.Carotid & Vertebral Artery Dissection Overview & Examples
3 m.Case - Embolic Stroke with ICA Dissection
5 m.Collagen Vascular Diseases Overview - Examples of FMD, Carotid Web
2 m.Case - Fibromuscular Dysplasia (FMD)
5 m.Case - Ehlers Danlos
7 m.Inflammatory Conditions with Stroke Symptoms - Examples of Takayasu's, TIPIC
4 m.Case - Takayasu’s Arteritis
4 m.Lesson
CTA Head
9 topics, 37 min.
CTA Head in Acute Stroke - Source Images, MIPS, Collaterals
4 m.Case - MCA Stem Embolus with Good Collaterals
5 m.Case - MCA Stem Embolus with Poor Collaterals
4 m.Case - Basilar Tip Thrombus
6 m.Circle of Willis Stenoses: Differential Diagnoses
2 m.Case - Moya Moya disease
6 m.Case - Reversible Cerebral Vasoconstrictive Syndrome (RCVS)
5 m.Case - Primary Angiitis of the CNS (PACNS)
7 m.Infectious Causes of Multifocal Circle of Willis Stenosis
2 m.Lesson
CT Perfusion
3 topics, 15 min.
Lesson
MRI (DWI, FLAIR, SWI) of Acute Stroke
3 topics, 14 min.
Lesson
MRA of Head and Neck
6 topics, 18 min.
Lesson
Multifocal Strokes With No Visualized Vascular Abnormality
6 topics, 26 min.
Lesson
Brain Ischemia, Hypoxia, & Death
6 topics, 16 min.
Lesson
Stroke Mimics & Other Causes of Restricted Diffusion
7 topics, 18 min.
Stroke Mimics - Other Causes of Restricted Diffusion
2 m.Case - Seizure (Stroke Mimic)
4 m.Case - MELAS (Stroke Mimic)
3 m.Case - Hypoglycemia (Stroke Mimic)
3 m.Case - Herpes Virus Encephalitis (Stroke Mimic)
4 m.Case - Osmotic Demyelination Syndrome (Stroke Mimic)
3 m.Case - Brain Metastases (Stroke Mimic)
4 m.Lesson
MR Perfusion
8 topics, 17 min.
MR Perfusion - Data, Maps and Uses
4 m.Case - MR Perfusion Target Mismatch (Good Collaterals)
2 m.Case - MR Perfusion Target Mismatch (Poor Collaterals)
3 m.Case - Ischemia Detected Only on MR Perfusion (Case 1)
2 m.Case - Ischemia Detected Only on MR Perfusion (Case 2)
3 m.Arterial Spin Labelling Perfusion - Usage Examples
3 m.Case - ASL Matched Defect
2 m.Case - ASL Showing Tissue at Risk
2 m.Lesson
Subacute Stroke & Differentials
5 topics, 13 min.
0:01
These are images of a 71-year-old
0:04
female who was last seen well five days
0:07
ago and had left-sided hemiparesis.
0:12
This is a non-contrast CT, and what we see
0:16
on the non-contrast CT is some hypodensity
0:19
in the temporal lobe and the insula, and we
0:22
see areas of hemorrhage within the insula
0:24
and the basal ganglia, and this goes up to
0:28
involve the inferior parietal lobe and the
0:31
right corona radiata, there's some mass effect.
0:34
So, hemorrhagic lesion.
0:38
First thing I'm going to say is this
0:40
corresponding to a vascular territory?
0:43
Well, it does fit the right MCA territory.
0:48
So, we got a CTA, so let's look at the CTA, and
0:52
you can see the CTA looks completely normal.
0:56
MCA branches look normal, they're
0:57
symmetric compared to the other side.
0:59
The PCA is normal.
1:00
We didn't see any major
1:02
thing going on in the neck.
1:04
So it kind of looks like it might be
1:06
in a vascular territory or not 100 percent
1:09
sure, not a tumor, a little weird for
1:14
venous infarction, but that's another
1:16
possibility amongst other etiologies.
1:20
And so the next thing we did was.
1:25
Get an MR.
1:26
You can see the FLAIR-weighted image, similar
1:30
to the CT, where you've got these areas
1:32
of edema and mass effect and some areas of
1:37
T2 dark signal, which is consistent with
1:40
the hemorrhage and on the SWI image, we
1:47
confirm that the hyperdensity is hemorrhage.
1:49
This is.
1:50
There's parenchymal hematomas in the
1:50
posterior insula and in the basal
1:55
ganglia and in the right parietal lobe.
1:59
There are some other tiny areas
2:01
of scattered microhemorrhages.
2:04
And what really helps us here is that what we
2:06
see on the diffusion-weighted image is areas
2:10
of restricted diffusion throughout This lesion.
2:16
So the dark signals, the hemorrhage, but
2:17
the rest of it, it's restricted diffusion.
2:20
And so this helps us confidently say
2:24
that, um, this was a subacute stroke
2:26
and not caused by another etiology.
2:29
The reason the vessels looked normal is because
2:31
there had been reperfusion, and with the pre
2:34
perfusion there were parenchymal hematomas.
Case - Subacute Stroke Evaluation (Case 3)
HIDEInteractive Transcript
0:01
These are images of a 71-year-old
0:04
female who was last seen well five days
0:07
ago and had left-sided hemiparesis.
0:12
This is a non-contrast CT, and what we see
0:16
on the non-contrast CT is some hypodensity
0:19
in the temporal lobe and the insula, and we
0:22
see areas of hemorrhage within the insula
0:24
and the basal ganglia, and this goes up to
0:28
involve the inferior parietal lobe and the
0:31
right corona radiata, there's some mass effect.
0:34
So, hemorrhagic lesion.
0:38
First thing I'm going to say is this
0:40
corresponding to a vascular territory?
0:43
Well, it does fit the right MCA territory.
0:48
So, we got a CTA, so let's look at the CTA, and
0:52
you can see the CTA looks completely normal.
0:56
MCA branches look normal, they're
0:57
symmetric compared to the other side.
0:59
The PCA is normal.
1:00
We didn't see any major
1:02
thing going on in the neck.
1:04
So it kind of looks like it might be
1:06
in a vascular territory or not 100 percent
1:09
sure, not a tumor, a little weird for
1:14
venous infarction, but that's another
1:16
possibility amongst other etiologies.
1:20
And so the next thing we did was.
1:25
Get an MR.
1:26
You can see the FLAIR-weighted image, similar
1:30
to the CT, where you've got these areas
1:32
of edema and mass effect and some areas of
1:37
T2 dark signal, which is consistent with
1:40
the hemorrhage and on the SWI image, we
1:47
confirm that the hyperdensity is hemorrhage.
1:49
This is.
1:50
There's parenchymal hematomas in the
1:50
posterior insula and in the basal
1:55
ganglia and in the right parietal lobe.
1:59
There are some other tiny areas
2:01
of scattered microhemorrhages.
2:04
And what really helps us here is that what we
2:06
see on the diffusion-weighted image is areas
2:10
of restricted diffusion throughout This lesion.
2:16
So the dark signals, the hemorrhage, but
2:17
the rest of it, it's restricted diffusion.
2:20
And so this helps us confidently say
2:24
that, um, this was a subacute stroke
2:26
and not caused by another etiology.
2:29
The reason the vessels looked normal is because
2:31
there had been reperfusion, and with the pre
2:34
perfusion there were parenchymal hematomas.
Report
Faculty
Pamela W Schaefer, MD, FACR
Professor of Radiology, Vice Chair of Education
Massachusetts General Hospital
Tags
Vascular Imaging
Neuroradiology
Neuro
MRI
Head and Neck
CTA
CT
Brain
© 2024 Medality. All Rights Reserved.