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Clinical Case of the Month: Acute Stroke

A stroke occurs when a blood clot clogs an artery or a blood vessel ruptures and interrupts normal blood flow to the brain. When a person suffers a stroke, their brain cells may begin to die and brain damage can occur, affecting normal brain activity that controls speech, movement, and memory. Stroke sufferers often experience sudden trouble speaking or understanding, sudden numbness in the face, arm or leg, sudden dizziness with trouble walking or balancing, and/or sudden severe headache.

According to the American Heart Association, stroke is the third leading cause of death, ranked behind heart disease and cancer. In 2006, over 137,000 people died as a result of stroke, and studies show that approximately 795,000 people suffer a new or recurrent stroke each year (~75% first attacks and ~25% recurrent)1

Computed Tomography (CT) scans are commonly used to diagnose stroke because they easily detect bleeding inside the brain and can be performed quickly to prevent further brain damage. Toshiba’s Aquilion ONE® 320-detector row dynamic volume CT scanner has the ability to reduce diagnosis time from hours or days to minutes by imaging an entire organ, such as the brain, in one rotation and show dynamic blood flow in real-time, critical for stroke patients.

Case Study: CT DSA, Brain Perfusion, and 3D TTP maps using dynamic volume CT was used to diagnose this acute stroke.

Technology: Toshiba Aquilion ONE 320-detector row dynamic volume CT.

Patient History: A 76-year-old woman was having dinner when she noticed difficulty finding words and with her speech. She called her internist, who advised her to take 325 mg of aspirin and go to the emergency room (ER). By the time she reached the ER, her symptoms had resolved. She was admitted for further evaluation and management. The acute stroke imaging protocol on the Aquilion ONE CT system was requested as a matter of priority. All diagnostic information was provided to the physician in 4.5 minutes.

Image Gallery

The CT DSA images clearly demonstrate near-complete occlusion in the inferior division of the left MCA at the M2 level, with collateral flow and reconstitution of some MCA branches distally. These images were generated automatically with perfect bone subtraction.

Abnormal perfusion is demonstrated in the left posterior temporal and parietal regions, characterized by increases in TTP and MTT, with a decrease in CBF. The CBV within this lesion is increased, indicating good autoregulation.

The fused 3D TTP maps are excellent for showing the anatomical relationships of the occluded MCA branch and the resultant perfusion deficit.

Images courtesy of Millard Filmore Gates Circle Hospital