bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamics of Dot‐Like Hemosiderin Spots on T2*‐Weighted MRIs Associated with Stroke Recurrence
Authors: Imaizumi Toshio , Honma Toshimi , Horita Yoshifumi , Chiba Masahiko , Kawamura Maiko , Miyata Kei , Kohama Ikuhide , Niwa Jun 
Published: October 2009

ABSTRACT Background and Purpose. Dot‐like low‐intensity spots (dot‐like hemosiderin spots: dotHSs) on gradient echo T2*‐weighted (‐w) brain magnetic resonance imaging (MRIs) are frequently associated with cerebral small vessel disease (SVD), including deep intracerebral hemorrhages and lacunar infarctions. This study investigated how numbers of newly appeared dotHSs contribute to recurrent SVD. Methods. We prospectively analyzed numbers of newly appeared dotHSs in 12 patients with prior SVD (8 males, 4 females; mean 67.6 ± 10.7 years old) readmitted with recurring SVD between October 2001 and March 2003. Numbers of appeared dotHSs per year were counted on T2*‐w MRI scans after SVD recurrence and compared to previous MRIs. Seventy‐one outpatients (35 males, 36 females; mean 64.3 ± 9.6 years old) with histories of intracerebral hemorrhages (ICH) that came to the hospital during the study period served as controls. The hazard ratio (HR) for recurrence was estimated from a multivariate logistic regression model, using the number of appeared dotHSs (per year) and other risk factors. Results. Multivariate analyses revealed that an elevated rate of recurrence was found in patients with substantial numbers of appeared dotHSs (≥5/year) (HR, 7.34; P= 0.0008). We also analyzed factors associated with the numbers of appeared dotHSs. A number of appeared dotHSs (≥5/year) was significantly and independently associated with the initial number of dotHSs (≥10) on T2*‐w MRIs following the first SVD (HR, 18.6; P= 0.0001). Conclusions. Though a small sample size limited the power of our analyses, our findings suggest that a number of newly appeared dotHSs may be associated with SVD recurrence.
Colloid Cyst: Diffusion MR Imaging Findings
Authors: Sener R. Nuri 
Published: October 2009

ABSTRACTColloid cysts usually have viscid gelatinous material or denser content. In an adult patient with a colloid cyst, diffusion magnetic resonance (MR) imaging was applied to detect its features with this sequence that if its viscous content may lead to a hyperintense appearance (decreased diffusion pattern) on b= 1000 sec/mm2 images similar to epidermoids. The colloid cyst had hypointense signal on the b= 1000 sec/mm2 image. The ADC map had more information that the ADC value of the cyst was 1.58 × 10−3 mm2/sec. This value was apparently higher than that of normal cerebral parenchyma, and was apparently lower than that of CSF. These diffusion MR imaging features of the colloid cyst are consistent with an elevated diffusion pattern in contrast to epidermoids.
Differentiating Intracranial Aspergillosis from a High Grade Glioma Using MRI and MR Spectroscopic Imaging
Authors: Pollack Erica , Bhaya Anil , Law Meng 
Published: October 2009

ABSTRACT We compare the MRI (magnetic resonance imaging) and MRSI (MR spectroscopic imaging) findings in a patient with intracerebral aspergillosis to those typically seen in an infiltrating high‐grade glioma (HGG). We demonstrate paramagnetic areas of T2‐hypointensity due to the pathologic deposition of iron and other paramagnetic elements seen in intracerebral aspergillosis. We also demonstrate the diffusion‐weighted imaging (DWI) findings and discuss how MR spectroscopy can be useful in differentiating an aspergilloma from a high‐grade glioma.
A Progressive Neurologic Disorder with Multiple CNS Lesions: A Neuroimaging Clinicopathologic Correlation
Authors: Chowdhary Sajeel , Chamberlain Marc 
Published: October 2009

ABSTRACTA 51‐year‐old man with a diagnosis of myelodysplasia and non‐Hodgkin's lymphoma underwent an unmatched allogenic bone marrow transplantation and was treated posttransplant with chronic immunosuppressive medication. Eight months following transplantation, he presented with progressive dysarthria, cognitive and visual decline. Evaluation included brain magnetic resonance (MR) imaging demonstrating multifocal areas of increased T2 and FLAIR (fluid attenuated inversion recovery) signals involving the left frontal, parietal, and occipital lobes. The MR lesions demonstrated diffuse increased signal on DWI (diffusion‐weighted images) and normal to low signal on ADC (apparent diffusion coefficients). Contrast‐enhanced T1 images were unremarkable. Lumbar puncture revealed a mild elevation in cerebrospinal fluid (CSF) protein. CSF PCR assay for viral DNA fragments were negative on two occasions. Serum serology for HIV was negative as well. A brain biopsy was subsequently performed. The clinical and neuroimaging differential diagnoses as well as neuropathologic correlation are presented.
Decompression Sickness: MRI of the Spinal Cord
Authors: Kei Pin Lin , Choong Chew Thye , Young Timothy , Lee Sze Haur , Lim C. C. Tchoyoson 
Published: October 2009

ABSTRACT Decompression sickness (DCS) typically causes changes in the white matter of the spinal cord on MR imaging. We present a case of DCS in a scuba diver with dorsal white matter lesions typical of venous infarction. In addition, some central gray matter involvement was noted. Characteristic features of venous spinal cord infarction can be recognized on MR imaging in DCS but may be more extensive in severe cases.
An Uncommon Variant of Fibromuscular Dysplasia
Authors: Spengos Konstantinos , Vassilopoulou Sofia , Tsivgoulis Georgios , Papadopoulou Marianna , Vassilopoulos Demetris 
Published: October 2009

ABSTRACTFibromuscular dysplasia is a rare cause of stroke affecting mostly young females. It is characterized by the typical “string of beads” sign located mostly bilaterally in the midcervical portion of the carotid or vertebral arteries. We present the uncommon case of borderzone hemispheric infarction in a man with isolated unilateral fibromuscular dysplasia affecting continuously the distal extracranial and proximal intracranial portion of the left internal carotid artery leading to distal hypoperfusion and ischemia.
Conventional MRI in Multiple Sclerosis
Authors: Filippi Massimo , Rocca Maria A. 
Published: October 2009

ABSTRACTDuring the past 10 years, conventional magnetic resonance imaging (cMRI) has become an established tool for the assessment of patients with multiple sclerosis (MS) and to monitor treatment trials. This is mainly due to the sensitivity and reproducibility of cMRI in the detection of MS‐related damage. A large effort has also been devoted to develop imaging strategies capable of providing accurate estimates of the extent of disease‐related damage not only in the brain, but also in the spinal cord and optic nerve. Guidelines have been defined to integrate MR findings in the diagnostic evaluation of patients at presentation with clinically isolated syndromes suggestive of MS, and specific acquisition protocols have been offered for monitoring longitudinal changes in patients with established disease. Despite the fact that the role of cMRI in MS has been profoundly obviated by the advent of modern and quantitative MR techniques, several issues are still unresolved. Technical development in acquisition and postprocessing, as well as the introduction of high‐field magnets in the clinical arena, are likely to increase our understanding of disease pathobiology, mainly through an increased ability to quantify the extent of gray matter damage.
Extensive Brainstem Ischemia on Neuroimaging Does Not Preclude Meaningful Recovery from Locked‐In Syndrome: Two Cases of Endovascularly Managed Basilar Thrombosis
Authors: Tomycz Nestor D. , Holm Margo B. , Horowitz Michael B. , Wechsler Lawrence R. , Raina Ketki , Gupta Rishi , Jovin Tudor G. 
Published: October 2009

ABSTRACTWe report 2 patients with angiographically demonstrated basilar artery thrombosis who received emergent intra‐arterial thrombolysis with successful recanalization of the basilar artery. In the ensuing weeks after the procedure, both patients were in a locked‐in state and had sustained large bilateral regions of pontine ischemia on brain imaging. Following aggressive supportive care and rehabilitation, outcomes obtained prospectively revealed that both patients made a remarkable recovery, becoming fully independent with Barthel scores of 20 and modified Rankin scores of 2.
Changes in Serum Calcium Levels Associated with Catheter‐Based Cerebral Angiography
Authors: Hassan Ameer E. , Hussain Muhammad S. , Chowdhury Farys , Khan Asad , Harris‐Lane Pansy , Qureshi Adnan I. 
Published: October 2009

ABSTRACTBACKGROUND AND OBJECTIVE Digital subtraction angiography is performed with agents such as iodinated contrast and intravenous heparin, which can alter electrolyte levels. If severe enough, these alterations may produce symptoms in patients in the post‐procedural period. We performed this study to evaluate serum calcium level changes after cerebral angiography. MATERIALS AND METHODS The preangiographic and postangiographic serum calcium levels of 87 patients were reviewed and analyzed. Patients were grouped based on when the postangiographic serum calcium level was drawn in relation to the angiographic procedure (0‐6 hours, 6‐12 hours, 12‐18 hours, and 18‐24 hours). RESULTS A significant reduction in serum calcium was observed in the 0‐ to 6‐hours, 6‐ to 12‐hours, and 12‐ to 18‐hours groups (P < .05). The differences between the preangiographic and postangiographic serum calcium levels were 0.91 mg/dL, 0.59 mg/dL, and 0.55 mg/dL in the 0‐ to 6‐hours, 6‐ to 12‐hours, and 12‐ to 18‐hours groups, respectively. The difference in the 18‐ to 24‐hours group (0.27 mg/dL) was not statistically significant. None of the patients was clinically symptomatic from this decrease in serum calcium levels. CONCLUSION An asymptomatic but significant decrease in serum calcium levels is seen following cerebral angiography. Possible mechanisms include chelation from the contrast agent or intravenous heparin. The reduction in serum calcium is transient, appearing to resolve within 24 hours.
Neuroimaging Findings in Hyperargininemia
Authors: Güngör Serdal , Akıncı Ayşehan , Fırat Ahmet Kemal , Tabel Yılmaz , Alkan Alpay 
Published: October 2009

ABSTRACTIn hyperarginenemia, there is a defect in argininase enzyme, which is a catalyzer of urea cycle. Though the pathogenesis of neuronal damage in hyperargininemia is not clear, high serum and cerebrospinal fluid arginine levels can be directly related with neuronal damage. In this study, our aim was to assess brain magnetic resonance images and magnetic resonance spectroscopy (MRS) patterns of two siblings with hyperarginenemia. We acquired single voxel MRS from the white matter to show the myelination pattern and to figure out any abnormal peak of metabolite stored due to enzymatic defect. We observed mild cerebral and cerebellar atrophy and infarct at bilateral posterior putamen and insular cortex localization on conventional images and elevated choline/creatine ratios and abnormal peak at 3.8 ppm, most likely representing arginine deposition. To the best of our knowledge, this is the first article revealing the brain MRS pattern of hyperargininemia. We reported the clinical and imaging findings of patients and discuss the correlation.
Systemic Thrombolysis Based on CT or MRI Stroke Imaging
Authors: Veronel Dimitro , Ringelstein Adrian , Cohnen Matthias , Yong Mei , Siebler Mario , Seitz Rüdiger J. 
Published: October 2009

ABSTRACTBACKGROUND Computed tomography (CT) and magnetic resonance imaging (MRI) are tools of investigation in acute stroke. We wondered if the additional information offered by MRI outweighs the disadvantage of its longer scanning duration for systemic thrombolysis. METHODS Two hundred ninety‐four consecutive patients (66 ± 13 years) were subjected to thrombolyis between 1999 and 2004. Inclusion criteria were ischemic infarction, scoring at entry and discharge with the NIH stroke scale and modified Rankin scale, systemic thrombolysis within 3 hours after symptom onset, multimodal MRI or standard CT. Subgroup analysis of 42 patients compared standard CT with CT and CT angiography. RESULTS Patients were similarly affected on admission (P > .1). At discharge, 6 days after stroke onset, the patients investigated with MRI were less impaired than those investigated with standard CT (P < .05). Symptomatic hemorrhage was rare in both groups. Also, patients investigated with CT and CT angiography were less impaired at discharge than those with standard CT (P < .02). A multifactorial regression showed that systolic blood pressure, glucose level and initial neurological impairment determined the neurological outcome at discharge. CONCLUSIONS Systolic blood pressure, glucose level and neurological impairment but not the imaging modality determined the neurological outcome following systemic thrombolysis in the 3‐hour window.
Studies on the Value of Diffusion‐Weighted MR Imaging in the Early Prediction of Periventricular Leukomalacia
Authors: Fu Jianhua , Xue Xindong , Chen Liying , Fan Guoguang , Pan Li , Mao Jian 
Published: October 2009

ABSTRACTOBJECTIVE Periventricular leukomalacia (PVL) is the most common cerebral injury in premature infants. While cranial ultrasonography and conventional magnetic resonance imaging (MRI) offer little for its early diagnosis, still they are much favored at present. Based on the pathologic mechanism of ischemic cerebral injury in PVL, we attempt to elucidate the effects of diffusion‐weighted MR imaging (DWI) for the early diagnosis of PVL. METHODS Twelve cases of PVL in premature infants confirmed by MRI examinations were included in the current study. All cases underwent DWI in addition to conventional MR imaging (T1‐weighted [T1W] and T2‐weighted [T2W]) 7 days, 2 weeks, and 4∼8 weeks after birth, respectively. RESULTS Initial DWI examination (carried out at an average of 4.5 days after birth) revealed symmetrical and diffuse high signal in bilateral periventricular areas in all cases, while conventional MRI demonstrated normal signal. DWI examination of 2 weeks later showed irregular inhomogeneous signals in cerebral white matter, while conventional MRI revealed hyperintensity on T1WI and slight hypointensity on T2WI in corresponding areas. Four weeks later, DWI revealed various intensities of cystic low signals beside lateral ventricles, while conventional MRI showed hypointensity on T1WI and hyperintensity on T2WI in corresponding lesion, ie, change in cystic PVL. Four months later, conventional MRI evidenced gradual shrink and disappearance of cystic cavity, reduction in cerebral white matter, and ventricle enlargement. CONCLUSIONS Symmetrical, diffuse hyperintensity in both lateral periventricular white matter on DWI was the earliest sign of PVL in premature infants. Imaging abnormalities provided by DWI had a close correlation with the results obtained by conventional MRI performed at the advanced stage of PVL, which suggests that DWI may be an important sequence for the early evaluation of cerebral white matter injury as well as for the prediction of PVL occurrence in premature infants.
Impact of Reperfusion after 3 Hours of Symptom Onset on Tissue Fate in Acute Cerebral Ischemia
Authors: Bang Oh Young , Liebeskind David S. , Buck Brian H. , Yoon Sa Rah , Alger Jeffry R. , Ovbiagele Bruce , Saver Jeffrey L. ,   for the UCLA MRI Investigators
Published: October 2009

ABSTRACTBACKGROUND Reperfusion of penumbral tissue is a promising strategy for treatment of acute cerebral ischemia more than 3 hours from symptom onset. However, there has been only sparse direct evidence that reperfusion after 3 hours prevents infarct growth. METHODS We analyzed clinical and serial magnetic resonance imaging (MRI) data on patients who received endovascular recanalization therapy 3‐12 hours after last known well time. Multimodal MRIs were acquired pretreatment, early (1‐20 hours), and late (2‐7 days) after treatment. Degree of recanalization was assessed on end of procedure catheter angiogram, degree of reperfusion on early posttreatment perfusion MRI, and infarct growth by analysis of diffusion lesion volumes on pretreatment and late MRIs. RESULTS Twenty‐seven (12 men, 15 women) underwent endovascular recanalization procedures at 6.0 ± 2.1 hours (range, 3.0‐11.5 hours) after last known well time. Immediate posttreatment perfusion lesion (Tmax ≥4 seconds) volume correlated strongly with infarct growth (r= .951, P < .001), exceeding the correlations of vessel recanalization score (r=−.198, P= .446) and pretreatment diffusion‐perfusion mismatch volume (r= .518, P= .033). Without reperfusion, enlargement of DWI lesion volume was observed in all patients, and extent of enlargement depended on volume of immediate posttreatment perfusion defects. CONCLUSION Our data indicate that posttreatment reperfusion is the major determinant of threatened tissue outcome, and suggest reperfusion even after 3 hours of symptom onset can alter tissue fate over a wide range of mismatch volumes.
Rheolytic Thrombectomy for Dural Venous Sinus Thrombosis
Authors: Modi Kalgi , Misra Vijay , Reddy Pratap 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Cerebral venous thrombosis is a rare condition. Its diagnosis and management can be difficult. Treatment options include systemically delivered anticoagulation or thrombolysis. Intrasinus thrombolysis is an increasingly used intervention but it increases the risk of hemorrhage, especially in patients who have a rapidly deteriorating neurological condition. Mechanical thrombectomy that provides rapid canalization without increased risk of hemorrhage is an attractive alternative treatment. METHODS We describe the use of AngioJet rheolytic thrombectomy in 4 patients with extensive cerebral venous sinus thrombosis, preexisting intracranial hemorrhage, and severe progressive neurological deficit despite heparin therapy. RESULTS Partial or complete sinus patency was restored in all 4 patients and complete neurological recovery was achieved in 3 patients. CONCLUSION Intracranial hemorrhage or a rapidly deteriorating neurological condition may preclude the use of thrombolytic agents in the treatment of patients with cerebral venous sinus thrombosis. In such patients, mechanical thrombectomy offers a useful alternative.
Premorbid Use of Statins Is Associated with Higher Recanalization Rates in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment
Authors: Georgiadis Alexandros L. , Hussein Haitham M. , Vazquez Gabriela , Shah Qaisar , Suri M. Fareed K. , Ezzeddine Mustapha A. , Qureshi Adnan I. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Statins have been shown to have lipid‐independent (pleiotropic) effects that may be beneficial in the management of vascular disease. We evaluated the effect of premorbid statin use on recanalization in patients with acute ischemic stroke undergoing endovascular treatment. METHODS We retrospectively reviewed the charts of all patients who had undergone endovascular treatment for acute ischemic stroke at our institution. Computed tomography scans obtained after treatment were assessed for the presence of hemorrhagic transformation by an independent reviewer. The primary endpoint was partial or complete recanalization (at least 1 grade improvement in the Qureshi scale). Secondary endpoints were hemorrhagic transformation and neurological improvement. Multivariate analysis was performed to evaluate the effect of premorbid statin use after adjusting for potential confounders. RESULTS Seventy‐seven patients fulfilled our inclusion criteria (mean age 66 ± 14, 38 were men) and among them 12 were on statins. The patients who were on statins had a higher recanalization rate (11/12 vs. 33/65, P= .02). This finding was confirmed by logistic regression analysis (odds ratio 17.25, 95% confidence interval 1.67‐177.43). There was no significant difference between the two groups regarding neurological improvement and hemorrhagic transformation. CONCLUSION This study demonstrates that patients on statins have higher recanalization rates when they undergo endovascular procedures for acute ischemic stroke.
Carotid Body Tumors: Advantages of Contrast Ultrasound Investigation
Authors: Giannoni Maria F. , Irace Luigi , Vicenzini Edoardo , Massa Rita , Gossetti Bruno , Benedetti‐Valentini Fabrizio 
Published: October 2009

ABSTRACT Carotid body tumors are rare neoplasms that have to be considered in the evaluation of all lateral neck mass. Early surgical removal has been recommended to avoid possible cranial nerve injury, the most common perioperative complication. Computed tomography (CT) and magnetic resonance imaging (MRA) angiographies are the preferred pre‐operative diagnostic imaging investigations, as well as the 111 In‐pentetreotide scintigraphic scan, whereas the standard ultrasound investigations have poor sensitivity in characterizing of the blood flows of the parenchimal structure of the carotid body tumors. We describe a case of a patient with a carotid body tumor assessed with contrast ultrasonography that clearly improved the quality of the standard color Duplex. This technique may represent a non‐invasive method, easy to use and to repeat, and able to achieve high diagnostic accuracy.
Medical Treatment of Patients with Intracranial Atherosclerotic Disease
Authors: Gomez Camilo R. , Qureshi Adnan I. 
Published: October 2009

ABSTRACT The medical treatment of patients with symptomatic intracranial atherosclerotic disease (ICAD) is directed toward reducing the risk of new ischemic events. The overall strategy is divided into: (1) prevention of occurrence of intraluminal thrombus, with or without embolism; (2) plaque stabilization and regression; and (3) management of atherogenic risk factors. In patients with ICAD, short‐term and long‐term anticoagulation (compared with aspirin) has not shown to be beneficial. The current guidelines recommend that aspirin monotherapy, the combination of aspirin and extended release dipyridamole, and clopidogrel monotherapy (rather than oral anticoagulants) are all acceptable options in patients with noncardioembolic ischemic stroke and transient ischemic attack. The findings of another pilot trial suggest that symptomatic ICAD is a dynamic lesion and cilostazol may prevent its progression. Overall, the subgroup analysis from randomized trials, provide evidence about benefit of aggressive atherogenic risk factor management among patients with ICAD. Current guidelines recommend statin therapy with intensive lipid‐lowering effects for patients with atherosclerotic ischemic stroke or transient ischemic attack with or without known coronary artery disease to reduce the risk of stroke and cardiovascular events.