 I'm Dr. Varun Nubai, junior resident MGM Medical College and Hospital, Navi, Mumbai. My topic for presentation is the role of MRI in evaluation and classification of acute stroke. For brief introduction, ischemic stroke is the most common neurological cause of severe disability and death. The risk of stroke generally increases in people over 60 years as blood vessels become harder and narrower with age. The stroke occurs when the blood flow to the brain is suddenly interrupted, depriving brain cells of oxygen and glucose and leading to further send death. Currently imaging techniques are the backbone of clinical management of stroke patients and have improved ability to visualize brain structures and are currently used to diagnose the affected vascular region. The aim of the study is to assess the value of MRI in making an accurate and timely diagnosis in patients with a neurological deficit. The objective is to list the findings of acute stroke in patients with a neurological deficit. Patients that have been included are those presenting with acute symptoms of stroke while those excluded are ones with long-standing symptoms of weakness, clinical picture not consistent with stroke and in the setting of trauma. My sample size is 30 and the study was conducted over a period of one month. Coming to some of the images, these are actual sections of brain MR showing flare and diffusion sequences. This is the first case, a 60-year-old male with a right-sided weakness. We see a well-defined, wedge-shaped area of restricted diffusion involving the gray and white matter of the left and right lobes, left and right lobes as well as left insular cortex. Coming to the angio of the same patient, we see a loss of flow-related signal density in the M3 and M4 segments of the left MCA. This was the left MCA directory in fact due to thrombotic occlusion of the M3 and M4 segments of the left MCA. Our next case is 61-year-old female with similar complaints of right-sided weakness. We see a large, well-defined area of restricted diffusion involving the gray and white matter of the left frontal parietal lobes as well as the left corona radiator. Looking at the angio, we see a loss of flow-related signal intensity involving all the segments of the left MCA, suggestive of thrombosis. This was again a case of left MCA directory in fact due to thrombotic occlusion of the left MCA. Our next case is a 56-year-old male with slurring of speech and weakness. We see a large, well-defined area of restricted diffusion involving the left frontal parietal temporal lobes as well as the right paracetal frontal lobes. The angio of this patient showed a loss of flow-related signal intensity involving all the segments of the left MCA as well as the left ACA, the right ACA. A3 and A4 segments of the right ACA and the visualized segments of the left internal carotid artery, suggestive of thrombosis. This was a case of left MCA and ACA directory in fact. Coming to our next case, 74-year-old male presenting with left-sided weakness. We see a well-defined area in the right, a well-defined area of restricted diffusion in the right occipital lobe which appears hyper intense on flare. The angio showed thrombosis of the P3 and P4 segments of the right PCA. This was a right PCA directory in fact. Our next case is a 59-year-old female with slurring of speech. We see a well-defined area of restricted diffusion involving the right coronary radiata which appeared iso intense on flare. This was a case of hyper acute non-hemorrhagic infarct. Our last case is 65-year-old male with right-sided weakness. We see a well-defined area of restricted diffusion involving the left coronary radiata with few areas of blooming on the gradient aqua sequences. This was a case of acute infarct with hemorrhagic transformation. Looking at the results, out of 30 patients with acute symptoms of stroke, 18 presented with findings on MRI consistent with stroke, which is about 60%. The remainder were due to other causes such as demyelination, tumor, infectious and metabolic disorders. Of the 18 cases, 14 of them were MCA directory infarcts, which were the most common. Why two were ACA as well as MCA directory infarcts and the remaining two were PCA directory infarcts. A brief discussion, ischemic stroke is an episode of neurological dysfunction due to focal infarction in the central nervous system attributed to arthritis, embolization or critical hyper-profusion. While ischemic stroke is formally defined to include brain, spinal cord, anodine and infarcts in common usage, it mainly refers to cerebral infarction. An ischemic stroke typically presents with rapid onset neurological deficit, which is determined by the area of the brain that is involved. The symptoms often evolve over hours and may worsen or improve depending on the fate of the ischemic phenomenon. The vascular directory affected will determine the exact symptoms and clinical behavior of the lesion. During the first week, the infarcted panchyma demonstrates high DWI signal and low ADC signal. Although by the end of the first week, ADC values start to increase. The infarct remains hyper intense on T2 and FLE, with T2 signal progressively increasing during the first four days. To summarize, acute ischemic stroke is a heterogeneous disease with major stroke caused by proximal artery occlusions, representing the stroke subtype with the most devastating outcomes. The primary role of imaging is to identify patients rapidly and accurately for effective treatment. MRI is particularly powerful in depicting the most important relevant physiology in acute ischemic stroke, the occlusion site and the size of the infarct. Thank you.