Discussion Author(s): 2LT Grant Lattin
Brain infarction may result from a number of causes, the most common of which is atherosclerosis. 60% of ischemic infarcts are related to atherosclerotic disease of the internal carotid artery. In the work up of a suspected stroke patient, CT is the recommended initial modality. However, MRI has been shown to detect earlier ischemic changes and detect infarcts not visible on CT. In the above patient, CT was used to quickly rule out intracranial hemorrhage as the cause of his altered mental status. CT scans performed in the initial 24 hours following a nonhemorrhagic infarct may be normal. CT findings depend on the size of an infarct, whether it is hemorrhagic in nature, the amount of time that has elapsed, and the location of the infarct. Signs of an acute infarct include loss of the border between gray and white matter and loss of the cortical sulci. Old infarcts can reveal an area of reduced density usually attributable to a single area of distribution. This area usually changes from an area of poorly marginated heterogeneous reduced density causing mass effect to an area with no sharp delineation, mass effect, and homogenous attenuation values. Typically, any mass effect is lost by 2 weeks and a sharp margin can be seen by 3 weeks.
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