Which imaging feature helps differentiate hemorrhagic stroke from ischemic stroke on CT?

Which imaging feature helps differentiate hemorrhagic stroke from ischemic stroke on CT?

• A. CT can only detect ischemia
• B. Hemorrhagic stroke is always hypodense
• C. Bleeding appears hyperdense (white) on CT
• D. Ischemia appears hyperdense

Answer: (C)

In acute stroke imaging, the big clue on a non-contrast CT is how blood looks. Fresh bleeding is hyperdense, meaning it appears bright white on CT. That bright area signals a hemorrhagic stroke. Ischemic tissue, especially in the very early minutes to hours, may look normal and then becomes darker (hypodense) as edema develops over time; it does not present as a bright hyperdense spot. This is why the hyperdensity finding is the clearest imaging feature distinguishing hemorrhage from ischemia and why it guides treatment decisions, such as avoiding thrombolytics if a bleed is present. The other statements aren’t accurate: CT can detect both hemorrhage and later ischemic changes, hemorrhage is not always hypodense, and ischemia is not typically hyperdense in the acute phase.

In acute stroke imaging, the big clue on a non-contrast CT is how blood looks. Fresh bleeding is hyperdense, meaning it appears bright white on CT. That bright area signals a hemorrhagic stroke. Ischemic tissue, especially in the very early minutes to hours, may look normal and then becomes darker (hypodense) as edema develops over time; it does not present as a bright hyperdense spot. This is why the hyperdensity finding is the clearest imaging feature distinguishing hemorrhage from ischemia and why it guides treatment decisions, such as avoiding thrombolytics if a bleed is present. The other statements aren’t accurate: CT can detect both hemorrhage and later ischemic changes, hemorrhage is not always hypodense, and ischemia is not typically hyperdense in the acute phase.