Ischemic Infarction in Young Adults

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Computed Tomography: 2.50
Procedures: 2.50
Head, Spine, and Musculoskeletal: 2.50

Magnetic Resonance Imaging: 2.50
Procedures: 2.50
Neurological: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Neurological, Vascular, and Lymphatic Sections: 2.50

Vascular-Interventional Radiography: 2.50
Procedures: 2.50
Vascular Diagnostic Procedures: 2.50

Outline

1. Introduction
2. Epidemiology
3. Clinical Approach
   1. Diagnosis
   2. Determining Cause
   3. Treatment
4. Imaging
   1. CT versus MRI
   2. Cross-Sectional Angiography
   3. Perfusion Imaging
   4. Vessel Wall Imaging
   5. Catheter Angiography
5. Causes
6. Cardioembolic Stroke
   1. Septic Emboli
   2. Bland Emboli
      1. Atrial Myxoma
      2. Patent Foramen Ovale
      3. Dilated Cardiomyopathy and Atrial Fibrillation
   3. Intravascular Air Emboli
   4. Fat Emboli
7. Other Demonstrated Causes
   1. Nonatherosclerotic Vasculopathies
      1. Dissection
      2. Carotid Web
      3. Reversible Cerebral Vasoconstriction Syndrome
      4. vasculitis
      5. Recreational Drug Use
      6. Cerebral Autosomal Dominant Arteriopathy with Dubcortical Infarcts and Leukoencephalopathy
      7. Moyamoya
   2. Prothrombic Disorders
      1. Factor V Leiden Mutation
      2. Antiphospholipid Syndrome
      3. Oral Contraceptive Use
      4. Pregnancy and Puerperium
8. Undetermined Cause
9. Small-Vessel Occlusion
10. Large-Artery Atherosclerosis
11. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the 5th leading cause of death in the United States
2. identify the subtypes of ischemic infarction
3. be familiar with the common stroke symptoms
4. be familiar with the reference for quantifying the severity of a stroke
5. identify the most common subtype of ischemic stroke in young adults
6. be familiar with the catchphrase for acute stroke treatment
7. understand the necessity for acquiring the LKWT
8. identify the young adults with ischemic infarction that can benefit from revascularization
9. be familiar with the advantages of using CT to assess acute ischemic stroke
10. be familiar with the advantages of MRI to assess acute ischemic stroke
11. be familiar with the perfusion parameters at CT perfusion imaging
12. be familiar with vessel wall imaging techniques
13. identify when catheter angiography is best suited for assessing stroke
14. be familiar with TOAST
15. identify a common cause of infectious endocarditis in young adults
16. be familiar with common primary cardiac tumors in young adults
17. be familiar with the percentage of adult patients with PFO
18. identify the modality of choice when diagnosing PFO in young adults
19. be familiar with the primary causes for cardioembolic infarcts
20. be familiar with the presence of the MRI imaging pattern exhibited with a fat embolism
21. identify the subcategories of the subtype Other Demonstrated Causes
22. be familiar with vasculopathy
23. identify the imaging modalities of choice when diagnosing a carotid dissection
24. be familiar with the diagnostic criteria for RCVS
25. identify the drug for treating RCVS
26. be familiar with the defect associated with a carotid web
27. be familiar with the routine workup for RCVS
28. identify an illicit drug that can lead to a catastrophic ischemic injury
29. be familiar with CADASIL
30. be familiar with the causes of moyamoya
31. be familiar with the percentage of moyamoya patients experiencing a cerebral infarction
32. be familiar with factor V Leiden mutation and its relationship with ischemic infarction
33. be familiar with the prothrombotic disorder of antiphospholipid syndrome
34. be familiar with the risk of cerebral venous thrombosis during puerperium
35. identify the patient risk factors associated with small-vessel occlusion