Contrast-Enhanced Computed Tomography as a Necessary Scan in Acute Stroke: A Case Series

We present a number of exemplary cases where the diagnostic value of the contrast-enhanced computed tomography (CT) after CT angiography in our acute stroke imaging protocol was of fundamental clinical significance.

We retrospectively reviewed 7 cases presented to the emergency room, between 2012 and 2014, suspected of acute stroke, with findings diagnosed by the contrast-enhanced CT.

Seven exemplary cases: acute midbrain infarct versus posterior-fossa artefact differentiation in contrast-enhanced CT; differentiation between an M1 occlusion and an internal carotid artery dissection in contrast-enhanced CT; diagnosis of veno-occlusive disease rather than arterial occlusion; bleeding arterial aneurysm revealed by contrast-enhanced CT; previously unsuspected sinus vein thrombosis; sinus vein thrombosis suspected in CT angiography, ruled out by contrast-enhanced CT; and space occupying lesion clearly diagnosed by contrast-enhanced CT.

Adding contrast-enhanced CT as a part of the acute stroke imaging protocol presents additional diagnoses and avoids pitfalls. Therefore, we consider the contrast-enhanced CT to be essential to the acute stroke setting imaging protocol.