Hyperacute Transcapillary Stroke - MR SWI

History

Acute change in neurologic status; rule out stroke.

Exam

Head MR SWI Sequence

Purpose

1 There is abnormal prominence (hyperemia) of the deep medullary veins within the diffusion positive stroke-zone, but without blooming. This implies post ischemic dysautoregulation, not venous stasis. It often is associated with contrast leak on the CTA.

2 There is SWI venous prominence with blooming artifact within the deep medullary veins implying significant venous stasis within the dense ischemic core of the stroke-zone.

3 There is virtual absence of the medullary veins deep within the stroke-zone.

4 There is SWI blooming artifact in proximal arteries indicating thrombosis.

5 There is SWI blooming along major cortical veins indicating thrombosis.

6 There is reduction in size of the ipsilateral major deep central veins indicating significant reduction in transcapillary blood flow. This increases the probability of malignant brain swelling.

7 There is hyperemia in the collateral zone from physiologic vasodilation.

8 There is SWI susceptibility artifact in the parenchyma included within the stroke-zone indicating sequestered infarction.

9 There is SWI susceptibility artifact within the stroke-zone to indicate hemorrhagic conversion.

10 There is SWI signal consistent with abnormal or physiologic brain calcification.

Prior Study

Any available

Findings

MR SWI

There is venous prominence (hyperemia) of the deep medullary veins without blooming artifact, which can reflect physiologically increased venous flow rate, or can be the result of congestion associated with a downstream venous outlet obstruction. [Yes/No]

There is SWI venous prominence within the deep medullary veins with blooming artifact, which implies significant venous stasis rather than physiologic hyperemia. [Yes/No]

There is reduction in size of the ipsilateral major deep central veins indicating significant reduction in transcapillary blood flow. [Yes/No]

There is SWI blooming artifact in proximal arteries indicating recent thrombosis. [Yes/No]

There is SWI blooming along major cortical veins indicating recent thrombosis. [Yes/No]

There is SWI susceptibility artifact in the parenchyma included within the stroke-zone indicating sequestered infarction (i.e. cortical laminar necrosis or parenchymal sequestered infarctions). [Yes/No]

There is SWI susceptibility artifact within the stroke-zone to indicate hemorrhagic conversion. [Yes/No]

There is SWI signal consistent with abnormal or physiologic brain calcification (focal absent nodular signal loss). It should be noted that chronic brain nodular calcification (as in sequelae of neonatal infections) are often not evident as a signal loss on SWI. [Yes/No]

Other

No other abnormalities are noted. [Yes/No]