Diagnosis and imaging of stroke.

Abstract

Less than 20 years ago the diagnosis of stroke was almost entirely based on clinical features. Since the mid-1970s sophisticated ultrasonography, computed tomography, magnetic resonance imaging, angiography and spectroscopy, single-photon emission computed tomography and positron emission tomography have been developed in rapid succession.By using a combination of imaging modalities it is now possible to show nearly all of the vascular tree from the left ventricle of the heart through to small arteries within the brain. Depending on clinical need, in most cases, it should be possible to define the location and mechanism of any given vascular event affecting the brain, and thus design appropriate management.Neuroimaging, clinical diagnosis and therapy are closely linked. Neuroimaging will become even more important if potential neuroprotective or thrombolytic agents prove effective. Categorization of pathophysiological subtypes of haemorrhagic and ischaemic stroke will allow more precise management of patients. If the rate of development in neuroimaging of the previous 20 years is maintained, even more precise evaluation of stroke patients will become possible.