Early signs on imaging studies even when very subtle, can paint a clear picture of Stroke prognosis to the astute observer. As neurologists, we rely heavily on paying particular attention to the finest details on imaging scans to evaluate early signs of tissue ischemia. In most cases this involves looking at CT scans, vessel imaging, and perfusion studies of the patients brain.

In a healthy well perfused brain, you see evidence of healthy tissue - preserved grey-white differentiation, a robust pattern of sulci and gyri) and perfusion studies that show preserved blood flow/volume (typically in shades of green, yellow) - this leads one to be hopeful and optimistic and representative of flourishing life.

In contrast, when brain tissue has infarcted, CT scans will show unhealthy tissue - a darkness or hypodensity, a loss of grey white differentiation, poor gyral/sulcal architecture known as sulcal effacement. And CT Perfusion studies with darker blue/purple hues to represent loss of volume and blood flow. This is often representative of tissue death and a hopeless, dark and unfavorable outcome.

Early recognition and detection of these patterns are a cornerstone of acute stroke management and prove to be invaluable tools in decision making for treatments as well as early prognostic markers.