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Neuroradiology

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01-06-2017 | Invited Review

Imaging of cerebral ischemic edema and neuronal death

Authors: Rüdiger von Kummer, Imanuel Dzialowski

Published in: Neuroradiology | Issue 6/2017

Abstract

Purpose

In acute cerebral ischemia, the assessment of irreversible injury is crucial for treatment decisions and the patient’s prognosis. There is still uncertainty how imaging can safely differentiate reversible from irreversible ischemic brain tissue in the acute phase of stroke.

Methods

We have searched PubMed and Google Scholar for experimental and clinical papers describing the pathology and pathophysiology of cerebral ischemia under controlled conditions.

Results

Within the first 6 h of stroke onset, ischemic cell injury is subtle and hard to recognize under the microscope. Functional impairment is obvious, but can be induced by ischemic blood flow allowing recovery with flow restoration. The critical cerebral blood flow (CBF) threshold for irreversible injury is ~15 ml/100 g × min. Below this threshold, ischemic brain tissue takes up water in case of any residual capillary flow (ionic edema). Because tissue water content is linearly related to X-ray attenuation, computed tomography (CT) can detect and measure ionic edema and, thus, determine ischemic brain infarction. In contrast, diffusion-weighted magnetic resonance imaging (DWI) detects cytotoxic edema that develops at higher thresholds of ischemic CBF and is thus highly sensitive for milder levels of brain ischemia, but not specific for irreversible brain tissue injury.

Conclusion

CT and MRI are complimentary in the detection of ischemic stroke pathology and are valuable for treatment decisions.

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Title: Imaging of cerebral ischemic edema and neuronal death
Authors: Rüdiger von Kummer
Imanuel Dzialowski
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 6/2017
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-017-1847-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Imaging of cerebral ischemic edema and neuronal death

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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