Diagnostic Criteria of Infarction in MRI of the Brain in Acute Stroke

Acute: Subtle low signal (hypointense) on T1, often difficult to see at this stage, and high signal (hyperintense) on spin density and/or T2-weighted and proton density-weighted images starting 8 h after onset; should follow vascular distribution. Mass effect maximal at 24 h, sometimes starting 2 h after onset, even in the absence of parenchymal signal changes. No parenchymal enhancement with paramagnetic contrast agent. Territorial intravascular paramagnetic contrast enhancement of “slow-flow” arteries in hyperacute infarcts; at 48 h, parenchymal and meningeal enhancement can be expected.

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Diagnostic Criteria of Infarction in CT Imaging of the Brain in Acute Stroke

Infarction: focal hypodense area, in cortical, subcortical, or deep gray or white matter, following vascular territory, or watershed distribution. Early subtle findings include obscuration of gray/white matter contrast and effacement of sulci, or “insular ribbon.”

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Clinical Criteria for Do-Not-Resuscitate (DNR) Orders in Acute Stroke

A DNR order may be written any time that two of the following clinical criteria are present and the prognosis has become clear for and shared whenever possible between physician(s), patient, and family (or appropriate surrogate).

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