bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real‐Time Hemodynamic Assessment of Intracranial Stenosis in a Patient with Orthostatic Aphasia: Potential Applications of Transcranial Doppler
Authors: Aladdin Yasser , Hussain Muhammad S. , Saqqur Maher 
Published: October 2009

ABSTRACTBACKGROUND Intracranial atherosclerotic stenosis is thought to be responsible for 8% of all ischemic stroke subtypes. Transcranial Doppler (TCD) ultrasonography allows for noninvasive and dynamic evaluation of the cerebral circulation within the circle of Willis. We present a case of recurrent, orthostatic transient ischemic attacks in which, using TCD, we were able to correlate dynamically between the orthostatic symptomatology and a significant drop in the mean flow velocity (MFV) across the stenotic middle cerebral artery (MCA) segment. METHODS A 56‐year‐old male presented with recurrent episodes of orthostatic right‐sided weakness and expressive aphasia. Diagnostic TCD revealed a stenotic signal in the left internal carotid artery (ICA) siphon. Subsequent TCD monitoring of both MCAs demonstrated a significant orthostatic drop in MFV of the left MCA, which closely correlated with his symptoms. The cerebral angiogram confirmed a high‐grade stenosis at the supraclinoid segment of the left ICA. CONCLUSION TCD is a useful, noninvasive, and dynamic tool for assessment of the intracranial circulation, and should be considered in the workup of patients with hypoperfusion cerebrovascular events.
Contrast‐Enhanced Transcranial Color‐Coded Duplex Sonography Criteria for Basilar Artery Stenosis
Authors: Tateishi Yohei , Iguchi Yasuyuki , Kimura Kazumi , Inoue Takeshi , Shibazaki Kensaku , Eguchi Katsumi 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE The aim of this study is to assess contrast‐enhanced transcranial color‐coded duplex sonography (CE‐TCCS) diagnosis of basilar artery (BA) stenosis. METHODS CE‐TCCS and cerebral angiography were performed in 120 consecutive patients. The patients were angiographically divided into five groups: (1) intracranial arteries (ICA) stenosis but no BA stenosis as intracranial stenosis (ICS) group, (2) both ICA and BA stenoses as internal carotid arteay and basilar arteay stenoses (IBS) group, (3) BA stenosis as basilar artery stenosis (BAS) group, (4) BA occlusion as basilar artery occlusion (BAO) group, and (5) no arterial lesions as Control group. We compared the peak systolic flow velocity (PSV) of BA using CE‐TCCS. RESULTS PSV was highest in the BAS group (n= 9, 206.1 ± 118.6 cm/sec), followed by the ICS (n= 27, 74.9 ± 36.1 cm/sec) and Control (n= 70, 58.2 ± 17.3 cm/sec) groups. IBS group had two patients (PSV: 102 cm/sec and 167 cm/sec). Sensitivity–specificity curve analysis revealed a cutoff PSV of 120 cm/sec to distinguish the BAS group from other groups, and then we calculated sensitivity of 100%, specificity of 95%, positive predictive value of 64%, negative predictive value of 100%, and accuracy of 95%. CONCLUSION Measurement of PSV of the BA using CE‐TCCS is useful for the identification of BA stenosis.
Reversible Parkinsonism After Treatment of Dural Arteriovenous Fistula
Authors: Nogueira Raul G. , Baccin Carlos E. , Rabinov James D. , Pryor Johnny C. , Buonanno Ferdinando S. , Hirsch Joshua A. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE The most common causes of parkinsonism are degenerative and irreversible. Structural causes of reversible parkinsonism are exceptionally rare, but have been reported in association with deep cerebral venous thrombosis and dural arteriovenous fistula (DAVF). We now report a case of parkinsonian syndrome reversed by treatment of a dural arteriovenous malformation. METHODS Case report with retrospective review of relevant clinical, imaging, and treatment data. RESULTS A 79‐year‐old man presented with complaints of a slowly progressive parkinsonian syndrome and tinnitus. Brain magnetic resonance imaging (MRI) showed numerous serpiginous flow voids highly suggestive of a vascular malformation. Cerebral angiography revealed a Cognard grade IIa + b left transverse sinus DAVF. The patient underwent combined endovascular and surgical treatment in three stages over a week's time, with total obliteration of the DAVF and complete normalization of his symptoms and neurological examination. CONCLUSION Although rare, DAVF should always be considered as a potential cause of progressive parkinsonism. This diagnosis is of great importance because of its potential reversibility.
Arterial Vasospasm During Mechanical Thrombectomy for Acute Stroke
Authors: Gupta Rishi 
Published: October 2009

ABSTRACTOBJECTIVE AND IMPORTANCE Mechanical maneuvers are being utilized more frequently to treat large artery occlusion responsible for acute ischemic stroke. Vasospasm due to vessel irritation during interventions may represent an etiology of poor recanalization in some patients. CASE REPORTS This report describes 2 patients who developed arterial vasospasm at the site of deployment of the L5 Merci retrieval device. The vasospasm was significant in nature and occlusive to one division of the middle cerebral artery. Both patients were treated with infusion of calcium channel antagonists with resolution of the narrowing. CONCLUSIONS Vasospasm after mechanical thrombectomy may represent a potential etiology for poor recanalization particularly if this is severe enough to cause complete occlusion. The use of pharmacological agents to treat suspected vasospasm should be considered during endovascular revascularization procedures for acute ischemic stroke, but care must be taken in monitoring decreases in blood pressure.
MRI Showing White Matter Lesions and Multiple Lobar Microbleeds in a Patient with Reversible Encephalopathy
Authors: Alcalay Roy N. , Smith Eric E. 
Published: October 2009

ABSTRACT Cerebral amyloid angiopathy (CAA) can rarely be complicated by vascular and perivascular inflammation. Patients typically present with subacute cognitive decline, seizures, headaches, and hyperintensities on T2‐weighted or fluid‐attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) sequences. Little is known about the cause and natural history of inflammatory CAA, but recent case series show that some patients respond well to steroids. Here, we describe a patient who presented with severe subacute encephalopathy and was diagnosed with probable CAA‐related inflammation based on characteristic MRI, showing subcortical FLAIR hyperintensities with mass effect and multiple cortical microbleeds, after excluding other possible causes of subacute delirium. Mental status examination markedly improved after a course of intravenous methylprednisolone, initially without significant change in MRI appearance. An MRI 4 months later, however, showed marked reduction in the volume of white matter T2 hyperintensities. Mental status remained improved with mild residual retrograde and anterograde amnesia. We propose that the diagnosis of CAA‐related inflammation should be considered in patients with profound subacute mental status changes and typical MRI findings. In steroid‐responsive patients, clinical improvement can precede radiographic improvement.
Relationship between Flow Diversion on Transcranial Doppler Sonography and Leptomeningeal Collateral Circulation in Patients with Middle Cerebral Artery Occlusive Disorder
Authors: Kim Yosik , Sin Dae‐Soo , Park Hyun‐Young , Park Man‐Seok , Cho Ki‐Hyun 
Published: October 2009

ABSTRACTBACKGROUND Flow diversion (FD) has been considered as indirect evidence of intracranial artery occlusion, and it was associated with early improvement in patients with MCA occlusion. It is not known whether FD can represent leptomeningeal collateral circulation or not in patients with middle cerebral artery (MCA) occlusive disorder. PATIENTS AND METHODS FD was defined by increased velocity (>30%) in anterior or posterior cerebral artery (ACA, PCA) compared to contralateral analogs artery in patients with MCA occlusive disorder. The leptomeningeal collateral channel (LMC) was identified using digital subtraction angiography. RESULTS A total of 51 patients were enrolled in this analysis. Transcranial Doppler (TCD) showed a FD in 47% (24) of patients. Twenty‐three patients had FD in ACA, and 1 patient in PCA. LMC was identified in 41% (21) of patients. Sensitivity of FD for leptomeningeal collateral circulation was 81%, specificity 76.7%, positive predictive value 70.8%, and negative predictive value 85.2%. Presence of FD showed good correlation with presence of LMCs in patients with MCA stenosis (r= .568, P= .00) CONCLUSION FD on TCD suggests the presence of leptomeningeal collateral circulation in patients with MCA occlusive disorder.
Leptomeningeal Collateral Volume Flow Assessed by Quantitative Magnetic Resonance Angiography in Large‐Vessel Cerebrovascular Disease
Authors: Ruland Sean , Ahmed Aiesha , Thomas Kurian , Zhao Meide , Amin‐Hanjani Sepideh , Du Xinjian , Charbel Fady T. 
Published: October 2009

ABSTRACTBACKGROUND/PURPOSE Leptomeningeal collateral volume flow has not been previously quantified. Quantitative magnetic resonance angiography (QMRA) can determine flow in the large vessels of the intracranial circulation. METHODOLOGY We reviewed consecutive QMRA studies performed between December 1, 2004 and August 30, 2005, for cases showing asymmetrically higher flow in a posterior cerebral artery (PCA) just distal to the origin of the posterior communicating artery ipsilateral to a hemodynamic middle cerebral artery (MCA) or internal carotid artery lesion. The mean, range, and standard deviation (SD) of the flow rate in the PCAs, MCAs, and PCA ipsilateral‐contralateral difference were calculated. Ipsilateral and contralateral PCA flow rates were compared using the Student's t‐test. RESULT Sixteen studies met selection criteria. Mean age was 52 years (range 21‐79) and 9 were female. MCA flow was below QMRA detection limits in 6 studies. Mean measurable ipsilateral MCA flow reduction was 84 mL/min (range 9‐147, SD 51.4). Mean ipsilateral PCA flow was 118 mL/min (range 72‐206, SD 38.5) and mean contralateral PCA flow was 68 mL/min (range 35‐144, SD 30.5, P < .001); mean difference was 50 mL/min (range 10‐93, SD 24.3). CONCLUSION Leptomeningeal collateral flow can be assessed with QMRA and may be substantial.
Granulomatosis with CNS Involvement: A Neuroimaging Clinicopathologic Correlation
Authors: Baaj Ali A. , Vale Fernando L. , Carter John D. , Rojiani Amyn M. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSETo present a rare case of a rheumatologic disorder with a central nervous system manifestation.METHODSA 48‐year‐old female with history of nasal and auricular pain and inflammation developed bilateral intermittent scleritis that was refractory to several immunosuppressive medications. She later presented with headaches and right upper extremity parasthesias. Brain magnetic resonance imaging (MRI) was obtained and she was referred to a neurosurgeon.RESULTSNeurological examination did not reveal any focal deficits. Laboratory analysis demonstrated an elevated erythrocyte sedimentation rate (ESR). Brain MRI with and without gadolinium contrast revealed an extra‐axial, enhancing, left frontoparietal convexity lesion. The patient was taken to the operating room for biopsy and resection of the mass. Final pathology demonstrated dural granulomatosis with vasculitis, most consistent with intracranial Wegener's granulomatosis. The patient was discharged to follow‐up with her rheumatologist for further medical management.CONCLUSIONSEnhancing, intracranial dural lesions are associated with a variety of disease entities. Wegener's granulomatosis is one such entity and should be considered in the correct context.
Ultrasonographic Reference Values for Assessing the Normal Median Nerve in Adults
Authors: Cartwright Michael S. , Shin Hae W. , Passmore Leah V. , Walker Francis O. 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE Several studies have evaluated the cross‐sectional area of the median nerve at the wrist, but none have examined other sites along the median nerve. Nerve enlargement has been demonstrated in entrapment, hereditary and acquired neuropathies, as well as with intraneural masses, and cross‐sectional area reference values at sites along the nerve will help in the evaluation of these conditions. In addition, muscle intrusion into the carpal tunnel has been implicated in carpal tunnel syndrome, but the normal amount of muscle intrusion has not been quantified. METHODS Fifty asymptomatic volunteers (100 arms) were evaluated to determine the mean cross‐sectional area of the median nerve at 6 sites and the mean amount of muscle intruding into the carpal tunnel. RESULTS The cross‐sectional area of the nerve was consistent along its course (7.5 to 9.8 mm2). The amount of muscle within the carpal tunnel varied greatly, with the mean area of flexor digitorum being 15.5 mm2 and lumbricals 13.5 mm2. CONCLUSIONS These reference values are necessary for advancing the field of neuromuscular ultrasound, because they facilitate studies of the median nerve in conditions such as entrapment, hereditary neuropathy, acquired neuropathy, and intraneural masses.
HLA‐DR2 and White Matter Lesion Distribution in MS
Authors: Sepulcre Jorge , Masdeu Joseph C. , Palacios Ricardo , Goñi Joaquín , Moreno Beatriz , Tainta Mikel , Bejarano Bartolomé , Villoslada Pablo 
Published: October 2009

ABSTRACTHuman leukocyte antigen DR2 (HLA‐DR2) is a well‐established genetic risk factor for multiple sclerosis (MS). However, it is still unknown whether this factor is associated with a specific disease phenotype, and in particular, to a regional distribution of white matter (WM) lesion phenotype on magnetic resonance imaging (MRI). On a voxel‐by‐voxel basis, we analyzed the T1 and T2 MRI‐derived lesion maps of 50 patients with MS in order to determine the possible influence of HLA‐DR2 genotype on the lesional MRI pattern at early stages of the disease. HLA‐DR2 was present in 15 (30%) patients of our cohort. They displayed similar WM lesion distribution as the subjects without this factor. Thus, lesion distribution in MS seems to be independent of the DR2 genotype.
Reduced Fractional Anisotropy in Early‐Stage Cerebellar Variant of Multiple System Atrophy
Authors: Oishi Kenichi , Konishi Junya , Mori Susumu , Ishihara Hiroyuki , Kawamitsu Hideaki , Fujii Masahiko , Kanda Fumio 
Published: October 2009

ABSTRACTBACKGROUND In patients with the cerebellar variant of multiple system atrophy (MSA‐C), reduced fractional anisotropy (FA) has been reported in several brain areas. However, since previous studies have employed predetermined regions of interest (ROI), the brain areas showing the earliest alterations in FA are unknown. The sensitivity of detecting early‐stage MSA‐C and the time course of the FA reduction are also unknown. The purpose was to address these issues to determine the diagnostic value of FA for early diagnosis. METHODS Twenty‐one patients with MSA‐C were investigated. Voxel‐based FA analysis and morphometry were used to detect the differences between early‐stage MSA‐C and normal controls. An ROI‐based FA analysis was also used to clarify the temporal profile. RESULTS From the early‐stage, MSA‐C patients exhibited reduced FA and white matter atrophy in the middle cerebellar peduncle, the inferior cerebellar peduncle, and the ventral pons. The FA of these areas decreased rapidly during the first few years after onset, after which a rather gradual reduction occurred. The receiver operating characteristics analysis revealed a high sensitivity and specificity for discriminating early MSA‐C from normal controls. CONCLUSIONS FA measurement could potentially be used to make an early diagnosis and monitor progression in MSA‐C patients.
Primary Non‐Hodgkin Lymphoma of the Skull Base Presenting with Garcin Syndrome: MRI Manifestations
Authors: Nakamura Ayami , Toyoda Keiko , Shozawa Yasunobu , Saito‐Arai Yuko , Shimizu Teruo , Matsumura Kiichiro 
Published: October 2009

ABSTRACT Primary non‐Hodgkin lymphoma of the skull base is a rare disorder. We report a case of primary non‐Hodgkin lymphoma of the skull base presenting with Garcin syndrome. MRI revealed peculiar lesions in the cavernous sinus, clivus, and occipital bone. Diagnosis was made by biopsy of the tumor in the cavernous sinus.
The Usefulness of CT Perfusion in Differentiation between Neoplastic and Tuberculous Disease of the Spine
Authors: Shankar J. , Jayakumar P. , Vasudev M. , Ravishankar S. , Sinha N. 
Published: October 2009

ABSTRACTINTRODUCTION Routine diagnostic techniques are not sufficient to confidently differentiate diseases of the axial skeleton. Purpose of study was to determine whether CT perfusion (CTP) can differentiate inflammatory diseases like tuberculosis from neoplastic diseases of spine. METHODS Fifty‐one patients with vertebrdraft%freshal body lesions associated with paraspinal mass underwent CT guided bone biopsy and histopathological evaluation. CTP was done before doing bone biopsy. Perfusion parameters like blood volume (BV), blood flow (BF), and time to peak (TTP) were calculated. Values are correlated with histopathological report of bone biopsy. Statistical analysis was done using Mann‐Whitney test. P value < .05 was considered significant. RESULTS Of 51, 32 had infective osteomyelitis and 19 neoplastic disease (9 metastasis, 5 plasmacytoma, 4 lymphoma and 1 chordoma. Mean rBF was [inflammatory lesions, 1.79 and neoplastic lesions, 9.42 (P < .000)]. Mean rBV was [inflammatory disease, 1.63 and neoplastic lesions, 9.37 (P < .000)]. CONCLUSION CTP technique has potential for differentiating inflammatory from neoplastic lesions affecting spine associated with paraspinal mass noninvasively.
Safety of Angioplasty and Stenting Without Thrombolysis for the Treatment of Early Ischemic Stroke
Authors: Abou‐Chebl Alex , Vora Nirav , Yadav Jay S. 
Published: October 2009

ABSTRACTBACKGROUND Strokes from large‐vessel atherosclerotic occlusions or severe stenoses are often resistant to re‐canalization with thrombolytic agents. As in acute coronary syndromes, angioplasty and stenting for stroke may be used to achieve timely reperfusion with possibly less risk for hemorrhagic complications. METHODS From a prospectively collected database, we have retrospectively reviewed cases of patients presenting acutely with an ischemic stroke or subacutely with fluctuating ischemic deficits due to a large‐vessel atherosclerotic stenosis and who were treated with angioplasty and stenting without thrombolytics. Endpoints were reperfusion based on the Thrombolysis in Myocardial Infarction (TIMI) score, procedural complications, parenchymal hematoma formation leading to neurologic decline, and 30‐day clinical improvement based on the National Institutes of Health Stroke scale (NIHSS). RESULTS Nine patients with a mean age of 70 ± 9 years and mean NIHSS of 18.3 ± 5.0 were treated. Culprit stenotic lesions were located in the extracranial internal carotid artery (ICA) origin (2), intracranial ICA (2), tandem stenosis in the extra‐ and intracranial ICA (3), and middle cerebral artery (2). Eight patients were treated with angioplasty and adjunctive stenting; one of these patients also required snaring of thrombus from the middle cerebral artery. One patient was treated with angioplasty of an intracranial ICA stenosis alone. TIMI 3 reperfusion was achieved in 8 (88.9%) patients. The mean 30‐day improvement in the NIHSS was 15.5 ± 5.6. Six patients had a NIHSS of 0 or 1 at 30 days. One patient died due to reasons unrelated to stroke or interventional procedure. There were no significant complications or parenchymal hemorrhages. CONCLUSIONS In appropriately selected patients with ischemic deficits due to large artery atherosclerotic stenoses, angioplasty with adjunctive stenting can be safely performed. Such interventions may improve outcome without the use of thrombolysis.
Visual Analysis or Semi‐Automated Gray‐Scale‐Based Color Mapping of the Carotid Plaque: Which Method Correlates the Best with the Presence of Cerebrovascular Symptoms and/or Lesions on MRI?
Authors: Momjian Isabelle , Momjian Shahan , Albanese Stéphane , Comelli Mario , Lovblad Karl , Sztajzel Roman 
Published: October 2009

ABSTRACTBACKGROUND AND PURPOSE To determine the correlation between carotid plaque morphology, assessed by two different ultrasonographic methods, and presence of cerebrovascular events and/or lesions on magnetic resonance imaging (MRI). PATIENTS AND METHODS Visual analysis of plaque echogenicity using a five‐type classification was performed. Further, a semi‐automated gray‐scale‐based color mapping of the whole plaque and of its surface was achieved. RESULTS There were 31 (35%) symptomatic (23 strokes and 8 transitory ischemic attacks [TIAs]) and 58 (65%) asymptomatic carotid stenoses. MRI lesions related to the carotid stenosis if located in the ipsilateral cortical, subcortical, or watershed area, were present in 27 cases (30%). In a multivariate logistic regression model, degree of stenosis (P= .03) and a predominant red color on the surface (P= .04) were independent factors associated with the presence of cerebrovascular events and/or lesions on MRI. Sensitivity and specificity were, respectively, 80% and 63% by combining degree of stenosis and color mapping of plaque surface. CONCLUSION Degree of stenosis and a predominant red color on plaque surface were independent factors associated with the presence of cerebrovascular events and/or lesions on MRI. No correlation was observed with any particular type of plaque based on visual analysis alone.
Internal Carotid Artery Stenting in Patients over 80 Years of Age: Single‐Center Experience and Review of the Literature
Authors: Linfante Italo , Andreone Vincenzo , Akkawi Nabil , Wakhloo Ajay K. 
Published: October 2009

ABSTRACTBACKGROUND Thirty percent to 40% of strokes in the elderly are secondary to carotid bifurcation disease. The treatment of internal carotid artery (ICA) stenosis in this patient population is a clinical dilemma. Age more than 80 years is a risk factor for carotid endarterectomy (CEA). Carotid artery stenting (CAS) may be also associated with increased peri‐procedural complications in this age group. DESIGN This study was a single‐center, retrospective database analysis evaluating CAS in patients more than 80 years old. Primary outcome included death, myocardial infarction (MI), or ipsilateral stroke. Secondary outcome included re‐stenosis at 30 days, 6 months, and 1‐year post‐procedure. RESULTS Between March 2001 and March 2004, CAS was performed in 178 patients. Twenty‐four patients were more than 80 years old (range 80‐91), and 16 men, 70.8%, were symptomatic. Success rate was 100% with residual stenosis of <20%. At the 30 days follow‐up there was 1 non‐Q wave MI (4.2%), 1 transitory ischemic attack (TIA), and 1 femoral occlusion in the symptomatic group. There were no deaths at 1‐year follow‐up evaluation as well as no ICA re‐stenosis. CONCLUSIONS CAS can be performed in patients more than 80 years old. Complications may be higher than in younger patients. However, because of the high prevalence of stroke in octogenarians, randomized trials should include this patient population.
Isolated Temporal Lobe Involvement in Japanese Encephalitis
Authors: Lu Suat‐Jin , Goh Poh‐Sun 
Published: October 2009

ABSTRACT Temporal lobe involvement on neuroimaging is extremely rare in Japanese encephalitis (JE) and isolated temporal lobe involvement on neuroimaging has rarely been described in the literature. With isolated temporal lobe involvement, distinguishing JE from the treatable Herpes simplex encephalitis (HSE) can be difficult. Both JE and HSE should be considered in patients who present clinically with acute encephalitis and have radiological evidence of temporal lobe involvement, especially in JE endemic areas.