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Skriver EB, Olsen TS. Repeated Computed Tomography in Lacunar Infarcts of the Brain. Acta Radiol 2016. [DOI: 10.1177/028418518903000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective and consecutive study of 74 patients with completed stroke elucidates occurrence, localization and evolution of lacunar infarcts on repeated CT examinations. Twenty patients had large infarcts (diameter >3 cm), 25 medium-sized infarcts (diameter ≥1.5 cm – ≤ 3 cm), and 16 had lacunar infarcts (diameter <1.5 cm). In 13 patients no infarct was seen. The lacunar infarcts were characterized by delayed appearance on CT, low incidence of fog effect, and infrequent presence of contrast enhancement. In 9 of the 16 patients (56%) the lacunar infarct could be identified on the first CT, performed approximately 3 days after the stroke. In 2 patients the infarct was first revealed on the second (2 weeks post stroke) and in 5 on the third CT (6 months post stroke). The delayed appearance might be due to a partial volume effect. Early development of fog effect may also be considered. As contrast enhancement was observed in only 8 per cent of the patients with lacunar infarcts on CT, and in 70 per cent of the entire group of patients in our series with ischemic infarcts, contrast enhancement seemed to be a function of lesion size.
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Affiliation(s)
- E. B. Skriver
- From the Department of Neuroradiology, Hvidovre Hospital, and the Department of Neurology, Bispebjerg Hospital, Denmark. Accepted for publication 6 August 1988
| | - T. S. Olsen
- From the Department of Neuroradiology, Hvidovre Hospital, and the Department of Neurology, Bispebjerg Hospital, Denmark. Accepted for publication 6 August 1988
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Bal S, Goyal M, Smith E, Demchuk AM. Central nervous system imaging in diabetic cerebrovascular diseases and white matter hyperintensities. HANDBOOK OF CLINICAL NEUROLOGY 2014; 126:291-315. [PMID: 25410230 DOI: 10.1016/b978-0-444-53480-4.00021-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes mellitus is an important vascular risk factor for cerebrovascular disease. This occurs through pathophysiologic changes to the microcirculation as arteriolosclerosis and to the macrocirculation as large artery atherosclerosis. Imaging techniques can provide detailed visualization of the cerebrovasculature using CT (computed tomography) angiography and MR (magnetic resonance) angiography. Newer techniques focused on advanced parenchymal imaging include CT perfusion, quantitative MRI, and diffusion tensor imaging; each identifies brain lesion burden due to diabetes mellitus. These imaging approaches have provided insights into the diabetes mellitus brain and cerebral circulation pathophysiology. Imaging has taught us that diabetics develop cerebral atrophy, silent infarcts, and white matter disease more rapidly than other patient populations. Longitudinal studies are needed to quantify the rate and extent of such structural brain and blood vessel changes and how they relate to cognitive decline. Diabetes prevention and treatment strategies will then be possible to slow the development of such changes.
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Affiliation(s)
- Simerpreet Bal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Eric Smith
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences and Radiology, Foothills Medical Centre, Calgary, Alberta, Canada.
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Coutts SB, Lev MH, Eliasziw M, Roccatagliata L, Hill MD, Schwamm LH, Pexman JHW, Koroshetz WJ, Hudon ME, Buchan AM, Gonzalez RG, Demchuk AM. ASPECTS on CTA Source Images Versus Unenhanced CT. Stroke 2004; 35:2472-6. [PMID: 15486327 DOI: 10.1161/01.str.0000145330.14928.2a] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system to assess ischemic changes on CT in acute ischemic stroke. CT angiography–source images (CTA-SI) predict final infarct volume. We examined whether the final infarct ASPECTS and clinical outcome were more related to acute CTA-SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS.
Methods—
ASPECTS was assigned by 2 raters on the acute NCCT, CTA-SI, and follow-up imaging. The mean baseline ASPECTS of acute NCCT and CTA-SI was compared with the follow-up ASPECTS. Rate ratios (RRs) were used to quantify the relationship between the dichotomized baseline ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcome.
Results—
Thirty-nine patients were recruited. Proximal occlusion (internal carotid artery or middle cerebral artery) was seen in 62%, M2 occlusion in 18%, and no occlusion was seen in 20% of patients. The median time between symptom onset and imaging was 1.9 (1.2 to 2.5) hours. There was a significantly larger difference of 1.4 between the mean baseline NCCT and CTA-SI ASPECTS in patients who had more ischemic changes (follow-up ASPECTS=0 to 3) than a difference of 0.6 in patients who had near-to-normal CT scans (follow-up ASPECTS=8 to 10). The rate of favorable outcome for acute NCCT ASPECTS of 8 to 10 was 51.8% versus 25.0% for 0 to 7 (RR, 2.1, 95% CI: 0.7 to 5.9,
P
=0.12). For acute CTA-SI ASPECTS of 8 to 10, the rate of favorable outcome was 58.8% versus 31.8% for 0 to 7 (RR, 1.8, 95% CI: 0.9 to 3.8,
P
=0.09).
Conclusions—
CTA-SI ASPECTS provides added information in the prediction of final infarct size.
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Affiliation(s)
- Shelagh B Coutts
- Seaman Family MR Centre, Foothills Hospital, Calgary Health Region, 1403 29th ST NW, Calgary, Alberta T2N 2T9, Canada.
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Pantano P, Caramia F, Bozzao L, Dieler C, von Kummer R. Delayed increase in infarct volume after cerebral ischemia: correlations with thrombolytic treatment and clinical outcome. Stroke 1999; 30:502-7. [PMID: 10066843 DOI: 10.1161/01.str.30.3.502] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Growing experimental evidence indicates that the development of cerebral ischemic damage is slower than previously believed. The aims of this work were (1) to study the evolution of CT hypoattenuation between 24 to 36 hours and 7 days in ischemic stroke patients; (2) to evaluate whether thrombolytic treatment given within 6 hours of stroke affects delayed infarction evolution; and (3) to investigate possible correlations between lesion volume changes over time and clinical outcome. METHODS Of 620 patients included in the European Cooperative Acute Stroke Study 1 (ECASS1), we selected 450 patients whose control CT scans at day 1 (CT1) and day 7 (CT7) were available. They had been randomly divided into 2 groups: 206 patients had been treated with rtPA and 244 with placebo. CT1 and CT7 were classified according to the location of the infarct. The volume of CT hypoattenuation was measured using the formula AxBxC/2 for irregular volumes. The 95% confidence interval of inter- and intrarater variability was used to determine whether significant changes in lesion volume had occurred between CT1 and CT7. Clinical severity was evaluated by means of the Scandinavian Stroke Scale (SSS) at entry (SSS0) and at day 30 (SSS30). RESULTS Mean lesion volumes were significantly (P<0.0001) higher at day 7 than at day 1 in all the subgroups of patients and particularly in patients with a subcortical lesion. Of the 450 patients studied, 287 (64%) did not show any significant change in lesion volume between CT1 and CT7, 143 (32%) showed a significant increase and the remaining 20 (4%) a significant decrease. No significant correlation was observed between treatment and lesion evolution between CT1 and CT7. Both clinical scores (SSS0 and SSS30) and degree of neurological recovery were significantly (P<0.05) lower in the subgroup of patients with a significant lesion volume increase than in the other 2 groups. CONCLUSIONS In approximately two thirds of patients, infarct size is established 24 to 36 hours after stroke onset, whereas in the remaining one third, changes in lesion volume may occur later than the first 24 to 36 hours. Many factors may be responsible for delayed infarct enlargement and for a lower degree of clinical recovery, both of which may occur despite early recombinant tissue plasminogen activator treatment.
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Affiliation(s)
- P Pantano
- Department of Neurological Sciences, Section of Neuroradiology, University of Rome "La Sapienza," Italy.
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Satoh H, Kurisu K, Ohtani M, Arita K, Okabayashi S, Nakahara T, Migita K, Iida K, Kuroki K, Ohbayashi N. Cerebral fat embolism studied by magnetic resonance imaging, transcranial Doppler sonography, and single photon emission computed tomography: case report. THE JOURNAL OF TRAUMA 1997; 43:345-8. [PMID: 9291384 DOI: 10.1097/00005373-199708000-00023] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cerebral fat embolism syndrome is an uncommon complication of trauma. We present a patient who developed cerebral fat embolism syndrome secondary to long-bone fractures. Although computed tomography of the brain failed to show any intracranial lesion, magnetic resonance imaging (MRI) detected scattered, high-signal-intensity lesions on T2-weighted images. 99mTc-d, 1-hexamethyl-propylene amine oxine single photon emission computed tomography (99mTc-HMPAO SPECT) and transcranial Doppler sonography (TCD) demonstrated low cerebral blood flow in the acute stage. MRI, 99mTc-HMPAO SPECT, and TCD correlated well with the clinical course of cerebral fat embolism syndrome.
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Affiliation(s)
- H Satoh
- Department of Neurosurgery, Hiroshima University School of Medicine, Japan
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Herderscheê D, Hijdra A, Algra A, Kappelle LJ, Koudstaal PJ, van Gijn J. Silent infarction on a second CT scan in 91 patients without manifest stroke in the Dutch TIA trial. Clin Neurol Neurosurg 1994; 96:219-21. [PMID: 7988089 DOI: 10.1016/0303-8467(94)90071-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The frequency of silent infarction is an important issue because it is a marker of vascular disease. We studied the occurrence of silent infarction in a sample of patients from the Dutch TIA trial, in which patients were randomized between 30 and 283 mg of aspirin. A total of 91 patients with TIA or non-disabling ischemic stroke and who did not suffer a stroke during a period of one to four years (mean 32 months) underwent CT scanning both on entry and at the end of the study. A cardiac source of embolism was an exclusion criterion for the trial. We found only one patient with a possibly silent infarction; in four patients a previously detected symptomatic infarct on CT was no longer visible. The rarity of silent infarction in this study may have several explanations; (1) the relatively short period of follow-up, (2) the selection of patients (no cardiac source of embolism), (3) the clinical monitoring at four monthly intervals aimed at detection of focal ischemia, (4) the use of aspirin. Given these circumstances, silent infarction is an infrequent problem.
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Affiliation(s)
- D Herderscheê
- Department of Neurology, Academisch Medisch Centrum, Amsterdam, The Netherlands
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Baker CJ, Ortiz O, Solomon RA. Resolution of focal CT hypodense lesions in patients with subarachnoid hemorrhage. SURGICAL NEUROLOGY 1993; 39:158-62. [PMID: 8351629 DOI: 10.1016/0090-3019(93)90096-j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cerebral infarction in the setting of vasospasm due to subarachnoid hemorrhage (SAH) is a known complication of aneurysmal rupture. Computed tomography (CT) has been instrumental in making this diagnosis; however, focal hypodense lesions on CT scan do not always represent infarcted tissue. Two patients are presented here who had CT hypodense lesions in regions of cerebral vasospasm following subarachnoid hemorrhage.
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Affiliation(s)
- C J Baker
- Department of Neurological Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, New York
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Evans GW, Howard G, Murros KE, Rose LA, Toole JF. Cerebral infarction verified by cranial computed tomography and prognosis for survival following transient ischemic attack. Stroke 1991; 22:431-6. [PMID: 2024270 DOI: 10.1161/01.str.22.4.431] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Of 564 consecutive patients with transient ischemic attack, 350 (62%) had cranial computed tomography performed. Except for date of admission and smoking history, there were few differences between the patients evaluated with computed tomography and the 214 who were not. Cerebral infarcts were found in 59 (17%) of the 350 tomographic evaluations. Previous clinically diagnosed stroke, older age, and male sex were all significantly associated with the occurrence of tomographically verified infarcts (p less than 0.05). After controlling for stroke history and other important covariates, patients with tomographically verified infarcts had significantly shorter survival times than did patients without evidence of infarction on computed tomography (p = 0.035). Thus, cranial computed tomography findings appear to have important prognostic value for estimating survival following transient ischemic attack.
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Affiliation(s)
- G W Evans
- Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, N.C. 27103
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Kawano Y, Ochi M, Hayashi K, Morikawa M, Kimura S. Magnetic resonance imaging of cerebral fat embolism. Neuroradiology 1991; 33:72-4. [PMID: 2027452 DOI: 10.1007/bf00593341] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The cerebral fat embolism is a potentially serious complication of fractures but clinical cases often go undiagnosed. Two cases of clinically diagnosed cerebral fat embolism are reported, and MR images of these patients are described. While brain CT revealed no abnormality, MR imaging showed relative low-intensity areas on T1-weighted images and high-intensity areas on T2-weighted images. In one patient follow-up MR showed nearly complete resolution of the abnormal signal. MR imaging appears to be valuable for detecting the lesions in these patients.
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Affiliation(s)
- Y Kawano
- Department of Radiology, Prefectural Hiroshima Hospital, Japan
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Asplund K. Randomized clinical trials of hemodilution in acute ischemic stroke. ACTA NEUROLOGICA SCANDINAVICA. SUPPLEMENTUM 1989; 127:22-30. [PMID: 2698587 DOI: 10.1111/j.1600-0404.1989.tb01807.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effects of hemodilution in acute ischemic stroke have been investigated, first in a single-center, then in a multicenter trial. Patients with hematocrit levels of 38-50% were randomized, within 48 h of onset of symptoms, to treatment with repeated venesections (total 250-1000 ml) and concomitant dextran 40 administration, or to a control group. The single-center study, performed in a research-oriented stroke unit, involved 102 patients. Case fatality rate was not grossly affected by hemodilution. In survivors, hemodilution improved neurological outcome. More hemodiluted patients were independent in walking and more were at home 3 months after the stroke. The ensuing multicenter trial involved 383 patients in 15 Scandinavian centers. Three-month case fatality rate was 16% in hemodiluted and 12% in control patients. Neurological scoring and ADL performance at 3 months was not improved by hemodilution. No subgroup with beneficial effects was discerned. It is concluded that the present standardized hemodilution regime cannot be recommended for general use in patients with ischemic stroke.
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Affiliation(s)
- K Asplund
- Department of Medicine, University Hospital, Umeå, Sweden
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Multicenter trial of hemodilution in acute ischemic stroke. Results of subgroup analyses. Scandinavian Stroke Study Group. Stroke 1988; 19:464-71. [PMID: 2896401 DOI: 10.1161/01.str.19.4.464] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a multicenter trial, 183 patients with acute ischemic stroke of less than 48 hours' duration and hematocrits of 38-50% were randomized to standardized hemodilution treatment (venesection and dextran 40 administration) and 190 to a control group. We have previously reported that there were no beneficial effects of hemodilution in the total patient population. In this report, the case fatality rates and neurologic outcome in survivors (3 months' follow-up) in subsets of patients have been analyzed. The patients were subgrouped by sex, age, medical history, smoking habits, delay from the onset of symptoms to the start of treatment, hematocrit at entry, venesection volume, neurologic score at entry into the study, blood pressure changes in the acute phase, presence of atrial fibrillation, location of brain lesion by computed tomography, type of diagnostic procedures, and hospital setting. No subset in which hemodilution reduced mortality or improved neurologic outcome could be identified. Case fatality rate was apparently higher in hemodiluted patients with infarction affecting deep brain structures than in control patients with such lesions. By simple clinical criteria, we have been unable to define subsets of stroke patients who benefit from the present standardized regimen of moderate hemodilution. The sample sizes are, however, too small to refute the possibility that a modest clinical effect of hemodilution may be present in some patients with stroke.
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