Help with MRI/Stroke

[mitts83]

I'm hoping someone can help me figure this out.  I had a stroke and I'm trying to figure out when it occured. This is important to me because whatever I was feeling at that time, I didn't think it was an emergency and thought nothing of it. Based on the DWI and ADC Map is there anyway of telling how old the stroke was? This is what they report said: An noteworthy area of increased signal intensity in the left medial occipital lobe. There is no bleeding into the lesion on the gradient-echo study. The lesion is in the superior bank of the calcarin cortex and to a lesser extent into the parietal region, consistent with her inferior contralateral visual field loss. The area had increased signal intensity on the diffusion weighted image, but I do not see a similar dark area on the ADC map, raising curiosity that this area is somewhat older. (How old?) There is no significant enhancement in the region with gadolinium. Other areas of increased signal intensity are quite mild and non specific. The lesion also predominantly affects cortical tissue, consistent with a stroke.

Is there any way of knowing if this stroke is 1 month, 3 months, 1 year old?
I'm 38, non smoker, low cholesterol and was wearing the ortho evra patch.

Thank you

[Sumer K Sethi, MD]

sounds correct to me. Yes be it a heart attack or brain stroke time is the key. Your neurologist will be the best person to advise you regarding the warning signs.

[mitts83]

Thank you so much. By the time I had the MRI they said I was past the point of emergency treatment and they started me on Agggenox. Does that sound correct? The date timeline is important to me to realize what my symptoms were to get to the hospital asap next time.

[Sumer K Sethi, MD]

Rapid assessment of acute ischemia is critical for the management of acute stroke patiens who may benefit from thrombolytics or neuroprotective therapeutics. Differentiation of acute from chronic stroke, which may all appear hyperintense on T2- Weighted Imaging(T2WI ), is essential in determining the management of patiens. This is essential because a single new ischemic event may treated differently from multiple new ischemic events, but differentiation between acute and chronic infarction cannot be easily determined from CT or T2WI. Diffusion-weighted imaging(DWI) has been shown to be useful in the early assessment of clinical stroke.  The apparent diffusion coefficient(ADC) of acutely ischemic brain tissue is initially below normal and increase to above normal after a few days.

Hyperacute and acute infarcts appear as areas of hyperintensity on DWI, and their average ADC is significantly depressed compared with homologous contralateral tissue and it  increased progressively as time pass and appeared as 'pseudonormal' values approximately 8 to 14 days, thereafter rADC became greater than normal in chronic stage. So in your case it looks like it is an infarct of 8-14days duration.