bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cortical Reorganization Allows for Motor Recovery after Crossed Cerebrocerebellar Atrophy
Authors: Feydy Antoine , Krainik Alexandre , Bussel Bernard , Maier Marc A. 
Published: November 2009

ABSTRACTThe authors report the case of a 33‐year‐old woman who exhibited, at the age of 17, a left‐sided hemiplegia, which was followed by good motor recovery, though with a permanent deficit in fine finger movements. She had a widespread loss of neural tissue in the right hemisphere (crossed cerebrocerebellar atrophy), including (1) marked atrophy and thinning of the precentral and postcentral gyri; (2)widespread deep white matter destruction, including the corticospinal tract; and (3) crossed cerebellar atrophy. Except over the supplementary motor area (SMA), transcranial magnetic stimulation did not elicit motor evoked potentials in the affected hand. Nevertheless, during opening and closing of the affected hand, functional magnetic resonance imaging showed an activation of the lesioned primary sensorimotor cortex (SMC), as well as of the intact SMA and the parietal areas, but not of the ipsilateral motor areas. The authors speculate that recovery was achieved by a motor command generated in the SMC and the parietal cortex, passing through corticospinal axons originating in the SMA.
Heidenhain Variant of Creutzfeldtjakob Disease: Diffusion‐Weighted MRI and PET Characteristics
Authors: Tsuji Yoshihisa , Kanamori Hiroshi , Murakami Gaku , Yokode Masayuki , Mezaki Takahiro , Doh‐Ura Katsumi , Taniguchi Ken , Matsubayashi Kozo , Fukuyama Hidenao , Kita Toru , Tanaka Makoto 
Published: November 2009

ABSTRACTCreutzfeldt‐Jakob disease (CJD) is characterized by rapidly progressive dementia with a variety of neurological disorders and a fatal outcome. The authors present a case with visual disturbance as a leading symptom and rapid deterioration in global cognitive functions. The cerebrospinal fluid was positive for 14‐3‐3 protein, and diffusion‐weighted magnetic resonance imaging (MRI) showed marked hyperintensity in the parieto‐occipital cortices, where hypometabolism was clearly detected on positron emission tomography (PET). Pattern‐reversal visual evoked potentials showed prolonged P100 latencies and increased N75/P100 amplitudes. All these findings supported a diagnosis of the Heidenhain variant of CJD, whereas a long clinical course, a lack of myoclonus, and an absence of periodic synchronous discharges on electroencephalography were atypical. Diffusion‐weighted MRI and PET in combination with visual evoked potential recording and 14‐3‐3 protein detection may be useful for the early diagnosis of CJD.
Aberrant Ascending Pharyngeal Artery Mimicking a Partially Occluded Internal Carotid Artery
Authors: Wei Chao‐Jung , Chang Feng‐Chi , Chiou See‐Ying , Teng Michael M. , Hu Han‐Hua , Chung Chih‐Ping , Chou Yi‐Hon , Chang Cheng‐Yen 
Published: November 2009

ABSTRACTDoppler sonography has become a primary imaging modality for the diagnosis of carotid arterial stenosis. Carotid stenting for a severely stenotic but not completely occluded carotid artery is becoming an alternative to carotid endarterectomy in selected groups of patients. The authors discuss a case of complete occlusion of the internal carotid artery associated with an ipsilateral aberrant ascending pharyngeal artery originating from the proximal internal carotid artery, which mimicked a stenotic internal carotid artery on sonography. Meticulous Doppler sonographic examination may provide clues for this extraordinary condition, yet angiography is indicated for a definite diagnosis.
Cerebral Metastasis from Heart Angiosarcoma Presenting as Multiple Hematomas
Authors: Liassides Charalambos , Katsamaga Maria , Deretzi Georgia , Koutsimanis Vasilios , Zacharakis Georgios 
Published: November 2009

ABSTRACTThe authors present the case of a 24‐year‐old woman with cerebral metastasis from a primary heart angiosarcoma, which appeared as multiple cerebral hematomas. Primary or metastatic brain angiosarcomas are exceedingly rare, and only a few cases have been reported with hemorrhage. Initial neurological symptoms were mild hemiparesis with numbness, and chest pain was first misdiagnosed as pericarditis. A computed tomography (CT) scan and magnetic resonance imaging showed 2 hematomas in the left parietal and occipital lobes. A thoracic CT scan revealed angiosarcoma of the right atrium of the heart with multiple infiltrations of the lung. The patient underwent surgical removal and systemic chemotherapy. She died 6 months after surgery.
Ultrasound‐Enhanced Thrombolysis for Acute Ischemic Stroke: Phase I. Findings of the CLOTBUST Trial
Authors: Alexandrov Andrei V. , Demchuk Andrew M. , Burgin W. Scott , Robinson David J. , Grotta James C. 
Published: November 2009

ABSTRACTBackground. Tissue plasminogen activator (TPA) activity may be enhanced with ultrasound, potentially 2 MHz transcranial Doppler (TCD). The authors present Phase I data of the CLOTBUST (Combined Lysis of Thrombus in Brain ischemia using transcranial Ultrasound and Systemic TPA). Subjects and Methods. Nonrandomized stroke patients with proximal arterial occlusion on a prebolus TCD receiving intravenous 0.9 mg/kg TPA within 3 hours after stroke onset were monitored with portable diagnostic TCD equipment and a standard headframe. Complete recanalization was defined as thrombolysis in brain ischemia (TIBI) flow grades 4–5. Results. 55 patients (mean age 69 ± 15 years, median baseline NIH Stroke Scale [NIHSS] 18, range 4–29, 90% with 39 points) were treated at 125 ± 36 minutes from symptom onset. TCD monitoring began at 117 ± 39 minutes. Complete recanalization on TCD within 2 hours after bolus was found in 20 patients (36%). Dramatic recovery (NIHSS score = 3) occurred in 20% at 2 hours and in 24% at 24ours. Overall improvement by = 4 NIHSS points was found in9% at 24 hours. Improvement was associated with recanalization during or shortly after TPA infusion (•r 2= .5, P=03); however, in 6/20 patients with complete recanalization (30%), no immediate clinical change was noticed within 2 hours. Overall symptomatic hemorrhage rate was 5.5%. Conclusions. Continuous TCD insonation for up to 2 hours at maximum intensities allowed by current bio‐safety guidelines is safe. Dramatic recovery and complete recanalization shortly after TPA bolus are feasible goals for thrombolysis given with TCD monitoring.
In Which Patients is Diffusion‐Weighted Magnetic Resonance Imaging Most Useful in Routine Stroke Care?
Authors: Keir S. L. , Wardlaw J. M. , Bastin M. E. , Dennis M. S. 
Published: November 2009

ABSTRACTBackground and Purpose. Magnetic resonance (MR) diffusionweighted imaging (DWI) has been used extensively in hyperacute cortical ischemic stroke, but its broader role in the assessment of patients presenting at later times after a wider variety of strokes has been less widely studied. Methods. The uthors assessed the clinical usefulness of DWI across a range of patients referred prospectively as either inpatients or outpatients. Detailed clinical information was collected. Diffusion DWI) and T2‐weighted images were read separately and blindly to clinical details. The presence of any infarct and its type were noted. Results. In 153 stroke patients, imaged at a median of 2 days (range, 6 hours to 77 days) after stroke, recent infarcts were identified more often on DWI (70%) than on T2‐weighted MRI (32%) in all severities of stroke. The proportion of scans on which relevant lesions were only seen on DWI was greatest among milder strokes due to small cortical or lacunar infarcts and among patients imaged later rather than earlier after the stroke. Conclusions. DWI is clinically useful up to several weeks after stroke, not just within the first few hours, and especially in patients with minor strokes.
The Use of PWI and DWI Measures in the Design of “Proof‐of‐Concept” Stroke Trials
Authors: Barber P. Alan , Parsons Mark W. , Desmond Patricia M. , Bennett Donald A. , Donnan Geoffrey A. , Tress Brian M. , Davis Stephen M. 
Published: November 2009

ABSTRACTBackground and Purpose. The authors used serial magnetic resonance perfusion‐weighted imaging (PWI) and diffusionweighted imaging (DWI) to determine whether major reperfusion and the attenuation of infarct expansion are associated with improved stroke outcome.Methods. Forty‐nine patients were studied with serial magnetic resonance imaging within 6 hours of stroke onset and again at 4 days (subacute studies) and 3 months (outcome studies). Two imaging parameters were examined: infarct expansion between acute and outcome studies and major reperfusion between acute and subacute studies.Results. Patients with major reperfusion (45% of those with acute PWI lesions) were more likely to have little or no disability at outcome (National Institutes of Health Stroke Scale [NIHSS] score = 4,P= .0176; Barthel Index [BI] score = 90,P= .0547)fter adjustment for baseline differences. In contrast, patients with infarct expansion (48%) were more likely to be dead or dependent at outcome (BI < 90,P= .0414; NIHSS scoreP= .082; modified Rankin Scale score > 2,P< .0001). These measures were used to generate sample size calculations based on hypothetical treatment effects. Therapies postulated to double the proportion of patients with major reperfusion from one third to two thirds would require 41 patients in each group (treated and untreated) to be sufficiently powered to show a difference. Interventions postulated to halve the number of patients with infarct expansion from 50% to 25% would require 66 patients in each group to show a difference.Conclusions. Infarct expansion and major reperfusion are associated with clinically meaningful changes in stroke outcome. These measures could be used as surrogate markers of outcome in late phase II proof‐of‐concept stroke studies designed to provide efficacy signals before embarking on large phase III studies with definitive clinical endpoints.
The Thickness of the Temporal Squama and Its Implication for Transcranial Sonography
Authors: Jarquin‐Valdivia A. A. , McCartney J. , Palestrant D. , Johnston S. C. , Gress D. 
Published: November 2009

ABSTRACTBackground and Purpose. The difficult transtemporal ultrasound window is a relatively frequent occurrence. The authors assessed if the thickness of the temporal bone squama as measured in the “bone window” of the head computerized tomography (CT) scan can predict the transtemporal acoustic window. Methods. The authors retrospectively reviewed the head CTs on their bone window setting of patients in which nonimaging transcranial Dopplers (TCDs) had been performed. The thickness of the temporal squama in its thinnest portion was measured. The temporal TCD windows were graded in three classes: class 1 as good, class 2 when only a partial study is possible, and class 3 as an impossible ultrasonic window. In a case‐control design, for every patient with any class 2 and 3 TCD temporal window, a patient with a class 1 window was randomly included from the same time period. Results. Fifty‐five temporal bones (56%) were class 1, 17 (17%) were class 2, and 27 (27%) were class 3. Bone thicknesses (in mm, mean ± SD) were greater in those with poorer windows: class 1 = 2.67 ± 0.70, class 2 = 4.06 ± 0.56, and class 3 = 5.04 ± 1.06, P= .0001y Cusick's nonparametric test of trend. Temporal squama thickness of = 5 mm portends 86% sensitivity, 90% specificity,0% positive predictive value, and a positive likelihood ratio of 8.6 for a class 3 transtemporal ultrasound window. Conclusion. Measurement of temporal bone thickness on the bone window setting of the head CT scan may be useful in identifying patients who are poor candidates for transcranial ultrasound.
Functional Magnetic Resonance Imaging of Working Memory among Multiple Sclerosis Patients
Authors: Sweet Lawrence H. , Rao Stephen M. , Primeau Margaret , Mayer Andrew R. , Cohen Ronald A. 
Published: November 2009

ABSTRACTBackground and Purpose. Verbal working memory (VWM) deficits have been a well‐replicated finding among patients with multiple sclerosis (MS). Functional magnetic resonance imaging (FMRI) studies have described a VWM system in healthy samples; however, functional neuroimaging of this system among MS patients is just beginning to appear. Methods. Fifteen MS patients and 15 sex‐, age‐, education‐, and IQ‐matched healthy control (HC) participants completed a 2‐Back VWM task as whole‐brain FMRI was conducted. Results. Each group exhibited increased brain activity compared to the 0‐Back control task in regions associated with the 2‐Back in previous neuroimaging studies. These included Broca's area, supplementary motor area (SMA), premotor cortices (PMC), and dorsolateral prefrontal cortices (DLPFC). MS patients exhibited greater cortical activity than did HC participants in left primary motor and somatosensory cortices, PMC, DLPFC, anterior cingulate, and bilateral SMA. MS patients exhibited relatively less activation in Broca's area, bilateral cerebellum, and other regions not typically associated with the 2‐Back (eg, right fusiform gyrus, left lingual gyrus, right hippocampus). Performance accuracy and reaction time did not differ between groups. Conclusions. Normal performance of a challenging VWM task among high‐functioning MS patients is associated with a shift toward greater activity in regions related to sensorimotor functions and anterior attentional/executive components of the VWM system. Posterior memory storage systems appeared unaffected, while portions of the visual processing and subvocal rehearsal systems were less active. Although a shift in neural activity was noted relative toHC participants, deviation from regions normally involved in VWM function was not observed in this patient sample.
Cerebral Vasospasm in Childhood Migraine During the Intermigrainous Period
Authors: Boasso Lauren E. , Fischer Asma Q. 
Published: November 2009

ABSTRACTBackground and Purpose. The aims of this study were to evaluate the changes in intracranial hemodynamics and assess the presence of vasospasm in children with migraine during the intermigrainous period. Methods. Transcranial Doppler (TCD) sonography findings, clinical examinations, and the vasospastic index of Lindegaard were analyzed for children who fulfilled the criteria for childhood migraine. The significance of the presence of vasospasm and abnormal hemodynamics were statistically analyzed using the normal approximation to the binomial test method. TCD sonography was performed using the standard published techniques for children. Results. Sixty‐two patients between the ages of 5 and 17 years who had undergone at least one TCD sonographic examination were selected for this study. A total of 113 TCD sonographic examinations were performed on the patients. Elevated mean blood flow velocities were found in 23 of 62 patients (37%) (P< .001). Early vasospasm was found in 4 of 62 patients (6.5%) (P< .001). Bruits were noted in 35 of 62 patients (56%). Conclusions. This study raises the possibility of cerebral vasospasm in the intermigrainous period in childhood migraine. Further studies are needed to elaborate on the pathophysiology of cerebrovascular behavior during this period. These findings may have a significant impact on the current clinical treatment of childhood migraine.
Is Magnetic Resonance Spectroscopy Superior to Conventional Diagnostic Tools in Hypoxic‐Ischemic Encephalopathy?
Authors: Wartenberg Katja E. , Patsalides Athos , Yepes Manuel S. 
Published: November 2009

ABSTRACTAnoxic brain injury carries a poor prognosis. Therefore, a diagnostic tool sensitive enough to predict its outcome is needed. The authors describe the case of a 51‐year‐old woman who suffered cardiorespiratory arrest. Electroencephalography, somatosensory evoked potentials, and magnetic resonance imaging did not prove to be useful in establishing a definitive prognosis. Magnetic resonance spectroscopy demonstrated the presence of significant neuronal loss in the cortex and cerebellum and was the only diagnostic procedure closely associated with this patient's prognosis.
Qureshi Grading Scheme for Angiographic Occlusions Strongly Correlates With the Initial Severity and In‐Hospital Outcome of Acute Ischemic Stroke
Authors: Mohammad Yousef , Xavier Andrew R. , Christoforidis Greg , Bourekas Eric , Slivka Andrew 
Published: November 2009

ABSTRACTBackground. The thrombolysis in myocardial infarction (TIMI) grading scheme and other classification systems have limitations in evaluating patients with ischemic stroke because they do not account for occlusion location or collateral circulation. The Qureshi grading scheme has been recently proposed to evaluate the severity of arterial occlusion in acute ischemic stroke because of limitations in existing grading systems. Methods. The Qureshi grading scheme assigns a score from 0 to 5 on the basis of occlusion site and collateral supply. The authors determined the relationship between initial severity of stroke and outcome at discharge measured by the National Institutes of Health Stroke Scale (NIHSS) and the Qureshi grading scale assessed from initial angiography (by a neuroradiologist blinded to the clinical examination) in 57 patients who underwent intra arterial therapy for acute ischemic stroke within 6 hours of symptom onset. Results. A strong association was observed between the initial severity of neurological deficits and Qureshi scheme on angiography (F ratio = 2.6, P = .03). The initial NIHSS for grade 1 was 11 ± 4 and progressively increased to 23 ± 6 for grade 5. In the multivariate analysis, initial NIHSS was significantly associated with Qureshi scheme on angiography (R2 = 358, P = .03). The mean discharge NIHSS was 12 ± 10 (range, 0–40). There was also a direct relationship between the Qureshi scheme and discharge NIHSS (F ratio = 2.8, P = .02).Conclusion. The Qureshi grading scheme can be effectively used to determine the severity of ischemic stroke (brain at risk) from the initial angiography.
Dot‐like Hemosiderin Spots on Gradient Echo T2*‐Weighted Magnetic Resonance Imaging Are Associated With Past History of Small Vessel Disease in Patients With Intracerebral Hemorrhage
Authors: Imaizumi Toshio , Horita Yoshifumi , Chiba Masahiko , Hashimoto Yuji , Honma Toshimi , Niwa Jun 
Published: November 2009

ABSTRACT Background and Purpose. Lipohyalinosis is considered an important cause of cerebral small vessel disease (SVD), including hypertensive intracerebral hematoma (ICH) and lacunar infarction. Dot‐like low‐intensity spots (dot‐like hemosiderin spots [dotHSs]) on gradient‐echo T2*‐weighted (T2*‐w) magnetic resonance imaging (MRI) have been histologically diagnosed as old microbleeds associated with microangiopathies (lipohyalinosis, amyloid angiopathy) and located in territories of perforating arteries (deep dotHSs) and subcortical regions (subcortical dotHSs). If dotHSs indicate the severity of lipohyalinosis, larger numbers of deep dotHSs may be associated with past history of SVD.Methods. The number of dotHSs was investigated in 213 patients with deep ICH (106 men, 107 women, 37 to 94 years old, mean age = 65.8 ± 11.2 years). Patients were divided into 2 subgroups according to past history of SVD. Odds ratio (OR) for the history was estimated from logistic regression analyses of the number of deep or subcortical dotHSs, as well as other factors.Results. Of 213 patients, 36 had a past history of SVD (symptomatic deep ICH in 18, symptomatic lacunar infarction in 17, and both in 1). An increased rate of history of SVD was found for patients with subcortical dotHSs. The OR per 1 subcortical dotHS was 1.09 (95% confidence internal (CI), 1.03–1.17;P= .005), and per deep dotHS, the OR was 1.07 (95% CI, 1.00–1.13;P= .039). Conclusions. The findings suggest that deep and subcortical dotHSs on T2*‐w MRI may indicate the severity of microangiopathy and may predict recurrence of SVD in patients with deep ICH.
Diagnosis of Moyamoya Disease with Transcranial Doppler Sonography: Correlation Study with Magnetic Resonance Angiography
Authors: Lee Yong‐Seok , Jung Keun‐Hwa , Roh Jae‐Kyu 
Published: November 2009

ABSTRACT Background and Purpose. Although the diagnosis of moyamoya disease may be confirmed by digital subtraction angiography, recent studies have shown the accuracy of mag netic resonance angiography. Characteristics of transcranial Doppler, a noninvasive and cost‐effective method, and specific transcranial Doppler parameters reflecting distinct vascular status in moyamoya disease are explored. Method and Patients. Consecutive patients (> 15 years of age) diagnosed with moyamoya disease by a typical clinical history and digital sub traction angiography or magnetic resonance angiography were included. The statuses of the anterior, middle, and posterior cerebral arteries were graded as stage 1, stage 2, and stage 3 by magnetic resonance angiography. Mean flow velocity and pulsatility index were compared between these groups, and the receiver operating characteristic analysis was used to define transcranial Doppler criteria for distinct vascular status. Results. Forty‐five patients were included (37 women; mean age, 34.9 ± 11.4 years). Mean flow velocity was higher and pulsatility index was lower in stage 2 (P < .01), while mean flow velocity was lower and pulsatility index was higher in stage 3 than in stage 1 (P < .01). Cutoff values reflecting stenosis or occlusion with substantial sensitivity and specificity were as follows: mean flow velocity > 85 cm/s or pulsatility index < 0.60 for stage 2, and mean flow velocity < 50 cm/s for stage 3 of middle cerebral artery; mean flow velocity > 80 cm/s or pulsatility index < 0.60 for stage 2 of anterior cerebral artery; and mean flow velocity > 60 cm/s or pulsatility index < 0.60 for stage 2 of posterior cerebral artery. Conclusion. Transcranial Doppler may help to refine magnetic resonance angiography findings and thus help clinicians differentiate severity or stages of moyamoya disease.
Changes in the Heterogeneity of Cerebral Glucose Metabolism with Healthy Aging: Quantitative Assessment by Fractal Analysis
Authors: Lee Jae Sung , Lee Dong Soo , Park Kwang Suk , Chung June‐Key , Lee Myung Chul 
Published: November 2009

ABSTRACT Background and Purpose. It has been shown that heterogeneity of cerebral glucose metabolism is increased in neuropsychiatric degenerative diseases. However, proper assessment of older patients requires knowledge about the effect of aging on hetero geneity. This study characterized the effects of aging on the heterogeneity of the distribution of cerebral glucose metabolism in healthy volunteers. Methods. Sixty‐six healthy volunteers (age range, 19–75 years) underwent flurodeoxyglucose brain positron emission tomography (PET), and all the PET images were spatially normalized onto a previously segmented standard brain template to parcel the brain regions automatically. Fractal dimension was regarded as a quantitative measurement for the heterogeneity of cerebral glucose metabolism and obtained for 9 brain regions. Participants were subdivided into young/midlife and elderly groups, and the Student t test was applied to the comparison of fractal dimensions in those groups. Analysis of covariance was performed for each region to explore the effects of age, gender, age‐by‐gender interaction, and total counts in the brain on the observed metabolic heterogeneity. Results. Fractal dimensions were higher for elderly volunteers in most brain regions. Differences between the 2 groups in fractal dimension emerged within the whole gray matter, temporal lobe, striatum, and cingulate. No significant gender differences, age‐by‐gender interactions, or total counts were observed. Significant age effects were observed in the whole gray matter, frontal lobe, temporal lobe, striatum, and cingulate gyrus. Con clusions. Heterogeneity in the cerebral glucose metabolism of healthy volunteers increased with age, and individual variations of heterogeneity were higher in older volunteers. However, there was no significant difference between male and female volunteers of the same age. The effect of age on heterogeneity was not regionally uniform.