MRI Brain Diffusion Report - Explanation for Mrs. Nagavva Navi (63F, dated 07-Aug-2026)

Patient & Scan Details

• Patient: Mrs. Nagavva Navi, 63-year-old female
• Scan type: MRI Brain with Diffusion-Weighted Imaging (DWI), FLAIR, and Haemosiderin sequences
• Centre: Eureka Diagnostic, Ichalkaranji

What the Report Found - Plain Language

1. Acute (Fresh) Brain Strokes (Infarcts)

• Right frontal lobe (front of brain - controls movement, personality, decision-making)
• Right parietal cortex and subcortex (middle-upper area - controls sensation, spatial awareness)
• Paramedian white matter (deep central white matter tracts)
• Insular cortex (deep inner region - involved in body sensation, autonomic control)

• No haemorrhagic transformation - the strokes have NOT bled, which is clinically important (makes thrombolytics/anticoagulants safer)
• No significant mass effect - the swelling has not shifted brain structures, which means no immediate herniation risk

2. Chronic (Old) White Matter Changes

3. Brain Atrophy (Shrinkage)

4. Reassuring Normal Findings

• Brainstem: unremarkable - no stroke in the brainstem (vital for breathing, consciousness)
• No intracranial haemorrhage - no bleeding anywhere in the brain
• No extra-axial collection - no blood clot or fluid outside the brain
• Paranasal sinuses: clear - no sinus infection

Summary of Impression (What the Radiologist Concluded)

What This Means Clinically

1. Cardiac evaluation - ECG and prolonged cardiac monitoring for atrial fibrillation (the most common embolic source in a 63-year-old woman)
2. Carotid Doppler ultrasound - to check for carotid artery stenosis/plaques
3. Antiplatelet or anticoagulant therapy - depending on the cause found (e.g., aspirin for non-cardioembolic, or a blood thinner like a DOAC if AF is confirmed)
4. Control of vascular risk factors - blood pressure, blood sugar, cholesterol
5. Stroke unit admission for monitoring, physiotherapy, and secondary prevention

Important note: This explanation is for informational purposes only. The report itself says "Suggest: Clinical correlation" - meaning the radiologist is asking the treating physician to interpret these findings in the context of the patient's symptoms, vital signs, and full clinical picture. Please consult the treating neurologist/physician immediately, as acute stroke requires urgent evaluation and management.

Acute Ischemic Stroke Management Guidelines (2025-2026)

Primary Reference: 2026 AHA/ASA Guideline

Key Updates and Recommendations

1. Prehospital & Systems of Care

• Mobile Stroke Units (MSUs) are now actively endorsed. Evidence shows improved outcomes versus standard EMS care for thrombolytic-eligible patients.
• Coordinated stroke networks remain central - outcomes depend on speed and efficiency across EMS, emergency departments, and hospital stroke teams.
• Bypass-to-EVT centers is only recommended if it actually speeds up reperfusion time - otherwise, nearest capable hospital is preferred.

2. Thrombolysis (IV Fibrinolytics)

• Tenecteplase dose: 0.25 mg/kg IV push (max 25 mg) - single bolus, simpler administration
• Alteplase dose: 0.9 mg/kg (max 90 mg) - 10% as bolus, remainder over 60 min
• Evidence base: EXTEND and TRACE-3 trials drove the extended window recommendation.
• Adjuvant antithrombotic + IVT (MOST trial 2025): Argatroban or eptifibatide added to IVT did NOT improve outcomes and increased mortality - Class III (No Benefit) in 2026 guideline.

3. Endovascular Thrombectomy (EVT)

• Large vessel occlusion (LVO): EVT remains standard of care within accepted time windows.
• Large-core infarcts: EVT now supported in selected patients with large-core infarcts who would previously have been excluded.
• Basilar artery occlusion (posterior circulation): EVT within 24 hours is recommended for patients with baseline mRS 0-1, NIHSS ≥10, and PC-ASPECTS ≥6 (Class I).
• Tirofiban pre-EVT: No benefit (Class III) - do not use.
• "Drip-and-ship" vs. "Mothership": Minimize door-in-door-out times; meta-analysis (D'Anna et al., JAHA 2026, PMID: 41717865) shows time-sensitive nature of transfer decisions.

4. Blood Pressure Management

5. Antiplatelet Therapy

• For mild, non-disabling AIS (NIHSS 0-5): Dual antiplatelet therapy (DAPT) - aspirin + clopidogrel - is preferred over IV thrombolysis.
• Antiplatelet agents should be withheld for 24 hours after IVT; follow-up imaging to exclude hemorrhage required before initiation.
• For cardioembolic stroke (e.g., atrial fibrillation): oral anticoagulation for secondary prevention, typically within 4 days; for smaller infarcts with low hemorrhagic transformation risk, a DOAC can be started as early as 24 hours post-stroke.

6. Glycemic Management

• Less aggressive glucose lowering is now endorsed in patients with persistent hyperglycemia. The 2026 guideline moves away from intensive insulin protocols, as the risk of hypoglycemia outweighs the benefit.

7. Neuroimaging

• Parallel processing of diagnostics is mandated - imaging, labs, and clinical assessment run simultaneously.
• Advanced imaging (CT perfusion or MRI DWI/perfusion mismatch) is used to select patients for extended-window thrombolysis.
• DWI-MRI remains the most sensitive modality for acute infarct detection (sensitivity 90-100%).

8. Neuroprognostication in Critical AIS

9. Special Populations

• Pediatric stroke: 2026 guideline provides first-time specific recommendations for IVT and EVT in selected children with AIS.

ESO 2025 Blood Pressure Guideline (European)

Take-Home Summary for Clinical Practice