Diffusion-weighted imaging in hyperacute haemorrhagic stroke patients presenting within thrombolysis window

INTRODUCTION

Diffusion-weighted imaging (DWI) in magnetic resonance imaging (MRI) has been proposed as the first line of neuroimaging for acute ischaemic stroke. The reliability of DWI in detecting intracranial haemorrhage, however, is still unproven, compared with susceptibility-weighted imaging (SWI) and CT scan which being considered the gold standard. This study seeks to establish the reliability of DWI as a first-line imaging modality to detect the intracranial haemorrhage in the patients present within the thrombolysis window.

MATERIALS AND METHODS

A retrospective cross-sectional analysis was performed on patients who presented to our institution from April 2020 until July 2021 for acute stroke and had MRI brain as first-line neuroimaging. A total of 31 subjects were included in this study. Two radiologists assessed the signal patterns in DWI sequence and compared them with SWI and CT Brain, whenever available, as the gold standard for observing the presence of intracranial haemorrhage.

RESULTS

The majority of patients with hyperacute bleed proven to be revealed on SWI or CT, thus showed characteristics of central hyperintensity and peripheral hypointense rim, on DWI. Slightly more than half (51.6%) presented with mild to moderate NIHSS scores (1-15). The sensitivity, specificity, positive predictive value and negative predictive value of DWI in detecting intracranial intra-axial haemorrhages were exceptionally high. There is strong interobserver level of agreement in identifying central haemorrhagic signal intensity [kappa = 0.94 (0.06), p < 0.05].

CONCLUSION

This study supported the DWI sequence as a reliable sequence in MRI, to detect intracranial haemorrhage in hyperacute stroke.

Follicular fluid vascular endothelial growth factor in normal and hyperresponder females and how it is affected by the type of trigger

OBJECTIVE

To study the type of trigger affecting the level of vascular endothelial growth factor in the follicular fluid of normal and hyper-responder females aiming to decrease the occurrence of ovarian hyper- stimulated syndrome.

METHODS

A total of 87 females with infertility, attending the Al sadder center in AL-Najaf Al -Ashraf city, for IVF were included in the study. PCOS were present in 48 women and the remaining had other causes of infertility. All of them used antagonist protocol and gonadotrophin. Triggering of ovulation was induced by hCG in non PCOS and GnRH- agonist in PCOS. Transvaginal aspiration of the follicles and measurement of follicular fluid VEGF was done.

RESULTS

A total of 87 infertile females were included in the study. They were divided in 2 groups; hyper -responders (48 cases)and normal responders 39 cases with male causes and tubal and unexplained etiology. No significant difference was observed between the hyper responders and the normal responders regarding age and BMI, (P<0.313 and 0.721 respectively) Using GnRH agonist as a trigger of ovulation in females with PCOS, lowering the level of VEGF, decreases the risk of developing OHSS.

CONCLUSIONS

using the GNRH agonist instead of hCG as a trigger in females with PCOS lowers the risk of developing OHSS.