Answer for BIR CoW 08 Jun 2025
Axial NCCT brain images shows, loss of grey white matter differentiation in right parietotemporal region and loss of right insular cortical ribbon at the level of right gangliocapsular region with hyperattenuation of distal M2 and M3 segment of right MCA reflecting thrombus.
Discussion
Signs of Hyperacute stroke in CT : - Loss of grey white matter differentiation. - Loss of insular cortical ribbon - Obscuration of lentiform nucleus -Hyperdense vessel MCA sign reflecting thrombus
Management of Hyperacute stroke:
Reperfusion therapy;
1.IV thrombolysis( IV tPA/ alteplase)
Eligibility: Ischemic Stroke Onset<4.5hrs No contraindications(active bleeding/recent Surgery)
Dose:0.9 mg/kg(max 90mg);10%bolus rest over 60 mins.
Newer agent : Tenecteplase 0.25 mg/kg IV Bolus.
2.Mechanical thrombectomy:
Eligibility: LVO(ICA and M1) NIHSS >6 Onset <6hrs (or extended window 6-24 hrs with favourable imaging)
In CT imaging, the "stroke window" refers to specific window settings (window level and width) used to optimize visualization of brain parenchyma and early ischemic changes, especially in the context of acute stroke evaluation.
CT stroke window settings:
Window length window width uses 30- 40. 80- 100. General brain 30-35 30-40
Stroke early Changes 1. Sacco R, Kasner S, Broderick J et al. An Updated Definition of Stroke for the 21st Century: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89. doi:10.1161/STR.0b013e318296aeca - Pubmed 2. Tomandl B, Klotz E, Handschu R et al. Comprehensive Imaging of Ischemic Stroke with Multisection CT. Radiographics. 2003;23(3):565-92. doi:10.1148/rg.233025036 - Pubmed 3. Lev M, Farkas J, Gemmete J et al. Acute Stroke: Improved Nonenhanced CT Detection--Benefits of Soft-Copy Interpretation by Using Variable Window Width and Center Level Settings. Radiology. 1999;213(1):150-5. doi:10.1148/radiology.213.1.r99oc10150 - Pubmed
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!