ABSTRACT
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This chapter presents an overview of magnetic resonance imaging (MRI) as a diagnostic approach
to stroke management. Over the last decade there have been major breakthroughs in stroke research
and the understanding of the pathophysiology of ischemic stroke has grown considerably.
Consequently, there have been numerous drug trials of acute stroke trying to take benefit from our
knowledge of the regulation of brain circulation and metabolism, glutamate excitotoxicity, peri-
infarct depolarization, free radicals, apoptosis, and inflammation. Yet, so far all of these efforts
using antiinflammatory and antiapoptotic drugs, growth factors, and gene therapy, to name but a
few, have shown disappointing results in clinical trials and thrombolysis is still the treatment of
choice for acute stroke within the first few hours after symptom onset. One reason for the failure of
these new therapies is that they usually affect only one aspect of stroke pathophysiology. Stroke,
however, is a heterogeneous disorder encompassing several etiologies with different pathobiolo-
gical mechanisms often co-existing in one patient. All of these may need a different therapeutic
approach and may be useful only in a distinct time window so that a specific treatment option may
be beneficial in one patient but of no benefit or even detrimental in another. Therefore, it seems
reasonable to apply improved selection criteria that allow categorization of those patients who have
a relevant indication for a given therapy from those who do not.
