Non-contrast Computed Tomography in Acute Ischaemic Stroke: A Pictorial Review.

Non-contrast computed tomography (NCCT) remains a widely used imaging technique and plays an important role in the evaluation of patients with acute ischaemic stroke. However, the task of identifying the signs of acute ischaemia and quantifying areas of brain involvement on NCCT scan is not easy due to its subtle findings. The reliability of early ischemic sign detection can be improved with experience, clinical history and the use of stroke window width and level on viewing the images. The Alberta Stroke Program Early CT Score (ASPECTS) was developed to overcome the difficulty of volume estimation in patients eligible for thrombolysis. It is a systematic, robust and practical method that can standardized the detection and reporting of the extent of acute ischaemic stroke. This article serves as an educational material that illustrates those findings which are important for all clinicians involved in acute stroke care.

CT-Guidance Combined with Fluoroscopy for Tunnelled Translumbar Catheterization of Inferior Vena Cava: A Technical Case Report

Patients with end-stage renal disease typically require catheter hemodialysis during the time required for fistula or graft maturation or after other methods of hemodialysis are exhausted. When patients requiring indwelling catheters develop central venous occlusions, unconventional routes to the central veins are used. Translumbar catheterization of inferior vena cava is considered as one of the options for central venous access. We highlight a case of Translumbar central venous tunelled catheterization performed under Computed Tomography (CT) guidance combined with fluroscopy in a 40-year-old lady with end-stage renal failure.

Planned Stage Endovascular Treatment for Complex Wide Neck Aneurysm

Treatment of a complex, wide neck aneurysm sometimes cannot be achieved in a single endovascular session. This case illustrates a planned stage endovascular treatment of a complex aneurysm with remodeling technique aiming to eliminate risk of rebleeding during acute phase in the first stage of treatment, and complete occlusion in the second stage of treatment. After first stage, separation between coil mass and neck remnant was clearly shown indicating presence of neointimal layer. Multiple sessions also provide proper planning and more controlled treatment of difficult aneurysms.

Endovascular Treatment of Cerebral Aneurysm: Early Experience in a Malaysian Tertiary Centre

Universiti Kebangsaan Malaysia Medical Center (UKMMC) started neurointerventional service in August 2008. In this study, we aimed to evaluate the immediate and short term outcome of endovascular treatment (EVT) of cerebral aneurysm during early period of the services. A retrospective study for cerebral aneurysm treated by endovascular technique, from the Neurosurgical and Radiology Department from September 2008 till February 2010 was performed. Patient’s demographic data, initial clinical presentation and assessment of the aneurysm were performed. The immediate results and short term assessment post EVT were evaluated based on standard criteria. Recurrence and complications during and following EVT procedures, were recorded. Twenty one patients with total of 22 aneurysms were treated. The mean age was 54.52 years with 57% being males and 43% females. The majority (81%) had single aneurysm. The most common site was anterior communicating artery (28 %). Mean aneurysm sac size was 6.19 mm and 2.55 mm for aneurysm neck. At follow-up, 3 (27.2%) had a small residual neck. Four patients (37.2%) had residual aneurysm filling, but three of them were treated with stent aiming to achieve flow diversion effect instead of complete occlusion during initial treatment. There was no rebleed or rupture from the immediate to follow-up. Significant complications up to 30-days was observed in 4 patients (20%) whereby 2 patients showed improvement and 2 patients died (10 % mortality rate). Endovascular treatment of cerebral aneurysms performed in our centre had early outcome, morbidity and mortality compared to other higher volume centres. Longer term follow up is needed to evaluate the long term outcome/occlusion rate, morbidity and mortality.

Neuroimaging features of tuberculous meningitis.

Tuberculous meningitis leads to a high mortality rate. However, it responds well to chemotherapy if the treatment is started early. Neuroimaging is one of the most important initial investigations. There were 42 patients diagnosed with tuberculous meningitis in Kuala Lumpur Hospital based on clinical criteria, cerebrospinal fluid analysis and response to anti-tuberculous treatment over a 7 year period. Relevant information was obtained from patients' medical case notes and neuroimaging findings were evaluated. Male to female ratio was 3:1. The three major ethnics and the immigrant groups in Malaysia were represented in this study. The majority of the cases involved the Malays followed by immigrants, Chinese and Indians. The patients' age ranged from 18 to 62 years old with the mean age of 34.4 years. There were 95.2% (n = 40) of patients who presented with various neuroimaging abnormalities and only 2 (4.8%) patients had normal neuroimaging findings. Hydrocephalus and meningeal enhancement were the two commonest neuroimaging features. Other features include infarction, enhancing lesion, tuberculoma, abcess, oedema and calcification. Contrasted CT scan is an adequate neuroimaging tool to unmask abnormal findings in tuberculous meningitis.

Giant aneurysm or pituitary macroadenoma: a diagnostical misconstrue.

We describe a case of a giant thrombosed intrasellar internal carotid artery aneurysm initially diagnosed as pituitary macroadenoma. The differentiating neuroimaging features were discussed.

Giant serpentine middle cerebral artery aneurysm.

A rare case of partially thrombosed giant serpentine right middle cerebral artery aneurysm presented. A 26 year old man initially presented with headache and 3 months later developed neurological deficit. Various stages of clot with patent residual lumen seen on neuroimaging, led to the diagnosis. Catheter angiography is the investigation of choice for evaluating the location, flow dynamics and extent of the serpentine aneurysm. The patient had embolisation done for the giant serpentine aneurysm.

Biological treatment of fishery washing water using Bacillus sphaericus coupled with production of spores that are toxic to mosquito larvae.

Research was undertaken to investigate the treatment of fishery washing water using Bacillus sphaericus, and to recover the spores for subsequent use as bioinsecticide to control the population of mosquitoes. This treatment method could reduce pollution due to organic matter by decreasing the value of Chemical Oxygen Demand (COD) and Biological Oxygen Demand (BOD) by about 85% and 92%, respectively. The maximum concentration of spores (83.3 x 10(7) spores ml(-1)) using normal concentration of filtered fishery washing water was only about 27% lower than that obtained in fermentation using 0.25% (w/v) yeast extract. The larvicidal activity of the spores produced in fermentation using fishery washing water to Culex quinquefaciatus, as measured by LD50 after 48 h, was almost the same as the larvicidal activity of spores obtained from fermentation using yeast extract.