[kstepanovs_485]

For cases like the one you describe I usually say something along the lines of “age indeterminate infarct given absence of priors for comparison.” I’ll also usually add to get an MRI if there is persistent concern for acute stroke. If you’re lucky enough to get a history then can try and see if the location correlates with their symptoms; but sadly I know that’s rare to get nowadays. 

[loli.amaral_506]

do you call the clinician then for those cases? or just leave it at age indeterminate

[Unknown Member]

Leave it. I have seen csf dense lesions get Mrd and the damn things restrict. Go figure.

[william.wang_997]

Age indeterminate. MR if needed to confirm.

[kstepanovs_485]

Would only call if the case is a stroke code or there is very high suspicion for stroke and the area in question corresponds with the history.

[dillersg]

My standard for those are depending on how confident I am is something to the effect of: Lacunar infarct which is age indeterminate without prior studies available. But favored to be chronic in the appropriate clinical setting. Correlate with symptoms and MRI can be obtained for further evaluation as needed.

The neurologist and most of the ER doctors will understand what you mean. The neurologists almost never call/complain if I give them that impression.

But I agree with what someone said above. Ive seen diffusion restriction on ones that I wouldve bet where chronic.

[dillersg]

Also. Just to add. The CT is meant to exclude demarcated large infarcts, mass effect, and hemorrhage. Anything else you tell them is a bonus. The good stroke neurologists already know this themselves.

We lost our battle with the ER over CTAs already. Some of the ER doctors think that a negative CTA excludes stroke.

[talia784]

As a neurorad, I almost don’t even explicitly look for stroke on my stroke CTs — just hemorrhage. If it’s big enough to matter, it’ll catch my eye.
 
If a small hypo density catches my eye and it’s not definitely old, I’ll call it age-indeterminant and rec MR without a phone call. But I try not to waste any brainpower on this as others have mentioned. 
 
In my experience with colleagues and myself, people are wrong about these as often as they’re right.

[pbernard_996]

What are peoples thoughts on using the term lacunar infarct outside of the basal ganglia? For example, is lacunar infarct an appropriate term for a small round infarct in the cerebellum? Or do you restrict the term only to the basal ganglia?

[dillersg]

One of my attendings in fellowship was dogmatic and only used the term lacunar infarct for basal ganglia and thalami. So Ive kind of adopted that as well. For the cerebellar ones I just say tiny, punctuate, or small depending on the scenario/referrer.

Another thing Ive noticed is that some rads call rounded white matter changes in the deep white matter as old infarcts. Ill only use that term if there is actual volume loss/ some central CSF signal on FLAIR. Otherwise I just say microvascular changes. Like a lot of things, Im not sure if clinically it matters since its all small vessel disease.

[talia784]

Agreed, I personally only say lacune for basal ganglia/thalami but see it used elsewhere including by neurorads and think nothing of it.

[smfst7_929]

Age indeterminate. Advise clinical correlation and proper neuro exam. If proper neuro exam cannot be performed, please re evaluate your clinical skills

[smfst7_929]

Quote from Apoplexy_

As a neurorad, I almost don’t even explicitly look for stroke on my stroke CTs — just hemorrhage. If it’s big enough to matter, it’ll catch my eye.

If a small hypo density catches my eye and it’s not definitely old, I’ll call it age-indeterminant and rec MR without a phone call. But I try not to waste any brainpower on this as others have mentioned. 

In my experience with colleagues and myself, people are wrong about these as often as they’re right.

Yo dont use ASPECT? For shame!