Cerebrovascular accident (CVA) is the medical term for a stroke. A stroke is whenblood flow to a part of your brain is stopped either by a blockage or the rupture of a bloodvessel. There are two main types of cerebrovascular accident, or stroke: an ischemic strokeis caused by a blockage; a hemorrhagic stroke is caused by the rupture of a blood vessel.Both types of stroke deprive part of the brain of blood and oxygen, causing brain cells todie.CVA also a sudden, non convulsive loss of neurologic function due to an ischemic orhemorrhagic intracranial vascular event. In general, cerebrovascular accidents areclassified by anatomic location in the brain, vascular distribution, etiology, age of theaffected individual.Cerebrovascular disease represents a major source of global mortality, with over 6million deaths documented annually, and is the second leading cause of death in all incomegroups worldwide, exceeded only by ischemic heart disease. In addition to being a leadingsource of mortality, cerebrovascular disease is also a significant cause of morbidity. Asmany as 50 % of stroke survivors do not regain functional independence, and 20 % requireinstitutional care 3 months after stroke onset.Diagnoses of CVA based on signs and symptoms, medical history, physical exam,and test results like MRI, CT scan. in this review we want to know why sometimes doctorrequest MRI otherwise request CT scan for same cases , and to know if there are a reasonsjudgement using of MRI or CT scan or both .In general we need to know why the gap isfounded .Comparison between MRI and CT scan in CVA diagnoses 3BRAIN COMPUTED TOMOGRAPHY:A brain computed tomography (to-MOG- rah-fee) scan, or brain CT scan, is apainless test that uses x rays to take clear, detailed pictures of your brain. This test often isdone right after a stroke is suspected. Brain CT scan can show bleeding in the brain ordamage to the brain cells from a stroke. The test also can show other brain conditions thatmay be causing your symptoms.MAGNETIC RESONANCE IMAGING:Magnetic resonance imaging (MRI) uses magnets and radio waves to createpictures of the organs and structures in your body. This test can detect changes in braintissue and damage to brain cells from a stroke An MRI may be used instead of, or inaddition to, a CT scan to diagnose a stroke.Does MRI better than CT scan in diagnosing of cerebrovascular accident (CVA).Literature review:Comparison between MRI and CT scan in CVA diagnoses 4Many studies performed about using of MRI and / or CT scan in diagnosing ofcerebrovascular accident (stroke). We want to take a snapshot about what had talked inliterature to determine which are best in CVA diagnoses MRI or CT scan or both .Josef Vymazal , Aaron M. Rulseh , Ji?í Keller and Ladislava Janouskova current CT andMRI methods employed in the management of stroke patients are reviewed, with anemphasis on ischemic stroke. the result was there are a number of factors come underconsideration. When ultrafast CT scanners covering almost the entire brain are used, thepotential to detect ischemia and salvageable tissue is almost equal in both techniques. Themajor drawback of CT is the high radiation dose; while in MRI it is the more complicatedand time consuming aspect of the examination. Thus, if any general practicalrecommendation can be made, acute stroke patients should be evaluated by native CTfollowed by perfusion CT, with MRI reserved for more chronic cases of brain ischemia orcontrol examinations in stroke patients. However, when state-of- the-art CT and high-quality MR scanners are utilized, both techniques are practically equivalent in the hands ofexperienced personnel.Jeban Ganesalingam and I Harri Jenkins conducted a study based on aretrospective case-notes audit of the investigation and management of 65 consecutivepatients referred to our rapid-access daily outpatient TIA service and seen by oneneurology trainee with consultant review. Our service is run to a performance standard ofseeing all high-risk patients within 24?h of referral and all low-risk patients within sevendays. High-risk patients are defined using the ABCD score . the results were Of the 65consecutive cases seen in clinic, 55% were initially diagnosed clinically as TIA or strokeComparison between MRI and CT scan in CVA diagnoses 5mimics. Of the 29 cases (45%) that were diagnosed clinically as TIA, all had CT brainscans and carotid Doppler ultrasound on the day of assessment. Twelve patients had MRIscans subsequently and 14 were followed up several weeks later. Of the 36 cases classifiedas stroke mimics, 27 had CT scans and 31 had carotid Dopplers. Six subsequently had MRIscans and 14 were followed up in the outpatient’s clinic. Only three of the 65 patients (twoinitially classified as TIA and one as a mimic) had their diagnosis revised following MRimaging François Moreau , Negar Asdaghi , Jayesh Modi , Mayank Goyal , and Shelagh B.Coutts conducted a study Consecutive patients aged 18 years or older presenting withminor stroke or high-risk TIA and who were examined by a stroke neurologist within 24 hof symptom onset were prospectively enrolled in the CATCH study. Patients who hadundergone both a baseline CT and an MRI within 24 h of symptom onset were included inthis sub study. Baseline MRI and CT were interpreted independently to identify an acuteischemic lesion. The rates of acute ischemic lesions on CT and MRI were compared, andthe volume of acute ischemic lesions was measured on MRI. In addition, the volume ofacute ischemic lesions on MRI was compared between patients who had evidence of acuteischemia on CT and in those who did not; the result was a total of 347 patients wereincluded, 168 with TIAs, 147 with minor strokes and 32 with a final diagnosis of a mimic.Acute ischemic lesions were detected in 39% of TIAs by using MRI versus 8% by using CTand in 86% of minor strokes by using MRI versus 18% by using CT. Compared to MRI,CT had a sensitivity of 20% and a specificity of 98% in identifying an acute ischemic lesion.The infarct volume on diffusion-weighted MRI was larger in cases where the CT alsoComparison between MRI and CT scan in CVA diagnoses 6showed an acute ischemic lesion as compared to lesions seen only on MRI. In Conclusion;MRI is superior to CT in detecting the small ischemic lesions occurring after TIA andminor stroke. Since these lesions are clinically relevant, MRI should be the preferredimaging modality in this setting.Lea Morrin Gerischer,JochenBFiebach,Jan F. Scheitz,Heinrich J. Audebert,Matthias Endres and Christian H. Nolte conducted a study based on data from a prospective, single-center observational study that included all patients with acute ischemic stroke whoreceived intravenous thrombolysis within 4.5 h. Stroke severity was assessed by theNational Institutes of Health Stroke Scale. Safety was assessed by rates of symptomaticintracranial hemorrhage (SICH), brain edema with mass effect and 7-day mortality.Outcome was assessed at 3 months as mortality and proportion of independent patients(modified Rankin Scale score between 0 and 2). The result were analyzed 345 patients ofwhom 141 received multimodal MRI and 204 received plain CT prior to treatment. Groupsdid not differ significantly in terms of age, neurological deficit, rate of elevated glucose levelor rate of very high blood pressure. However, patients with CT-based thrombolysis hadsignificantly higher rates of cardiac comorbidities. In the MRI group, we observed a lowerrate of 7-day mortality, a lower rate of SICH and a non significantly lower rate of brainedema with mass effect. In multivariable analysis, 7-day mortality was independentlyassociated with MRI-based thrombolysis, even if cardiac comorbidities were taken intoaccount. For mortality at 3 months, there was a nonsignificant difference in favor of theMRI group. In multivariable analyses, mortality at 3 months was independently associatedwith older age, higher stroke severity, brain edema with mass effect, SICH, pneumonia andComparison between MRI and CT scan in CVA diagnoses 7coronary artery disease. Neither mortality nor independent outcome was influenced byinitial imaging modality.Conclusion:According to the review of the literature the gap is still founded. Some researchesprefer use of MRI instead of CT scan otherwise researches prefer CT scan. Furtherinvestigations need to be done to determine which best to use in stroke MRI or CT scan.