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Abstract:

Aim: was to identify features of disorders of brain perfusion and diffusion in venous stroke anc arterial stroke by CT and MRI.

Material and methods: in groups with acute venous stroke due dural sinustrombosis without primary hemorrhage (n=39) and atherothrombotic stroke (n=33) were performed perfusion CT (with relative MTT, CBV CBF) and MRI (with relative DWI and ADC), besides routine CT and CTA.

Results: rMTT in central areas were not different, but in venous stroke perifocal zone rMTT=1.27±0.2 vs. 1.68±0.6 in arterial stroke (p=0.00001); rCBF=0.76±0.5 vs. 0.36±0.2 focal and 1.28±0.25 vs. 0.69±0.26 perifocal (p=0.00001); rCBV=0.89±0.4 vs. 0.55±0.25 focal (p=0.0000001) and perifocal 1.28±0.25 vs. 1.07±0.42 (p=0,0006); rDWI = 1.69±0.34 vs. 2.11±0.47 focal (p=0.0001) and rDWI=1.1±0.4 vs. 2.14±0.32 perifocal (p=0.0039); rADC in central zone of venous lesions average 1.26±0.99 vs. 0.63±0.25 arterial stroke (p=0.0018); perifocal no different. A high correlation (r=0.95) was found when comparing the area affected (cm2) on CBV and DWI maps.

Conclusion: MR or CT perfusion and MR diffusion imaging in acute stroke make it possible to distinguish between primary arterial ischemic brain damage from congestive plethora due venous stroke. Perfusion-diffusion mismatch venous stroke has a different origin than in arterial stroke. If infarction is not formed benign hyperemia (not oligemia) - early vasogenic edema identified like basis of venous stroke. Venous ischemia is secondary and is associated with an externally constriction of microcirculation.

 

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