[Imaging in acute ischemic stroke using automated postprocessing algorithms]. / Bildgebung beim akuten ischämischen Schlaganfall unter Verwendung automatisierter Analysealgorithmen.

There are several automated analytical methods to detect thromboembolic vascular occlusions, the infarct core and the potential infarct-endangered tissue (tissue at risk) by means of multimodal computed tomography (CT) and magnetic resonance imaging (MRI). The infarct core is more reliably visualized by diffusion-weighted imaging (DWI) MRI or CT perfusion than by native CT. The extent of tissue at risk and endangerment can only be estimated; however, it seems essential whether "tissue at risk" actually exists. To ensure consistent patient care, uniform imaging protocols should be acquired in the referring hospital and thrombectomy center and the collected data should be standardized and automatically evaluated and presented. Whether patients with a large infarct core and with or without tissue at risk or patients with large vessel occlusion (LVO) but low NIHSS benefit from thrombectomy has to be evaluated in controlled clinical trials using standardized imaging protocols. A promising, potentially time-saving approach is also native CT and CT angiography using a flat-panel detector angiography system for assessment of vessel occlusion and leptomeningeal collaterals.

Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation.

BACKGROUND AND PURPOSE: 4D flow MR imaging is an emerging technique that allows visualization and quantification of 3D blood flow in vivo. However, representative studies evaluating its accuracy are lacking. Therefore, we compared blood flow quantification by using 4D flow MR imaging with US within the carotid bifurcation. MATERIALS AND METHODS: Thirty-two healthy volunteers (age 25.3 ± 3.4 years) and 20 patients with ≥50% ICA stenosis (age 67.7 ± 7.4 years) were examined preoperatively and postoperatively by use of 4D flow MR imaging, with complete coverage of the left and right carotid bifurcation. Blood flow velocities were assessed with standardized 2D analysis planes distributed along the CCA and the ICA and were compared with US at baseline and postoperatively in patients. In addition, we tested reproducibility and interobserver agreement of 4D MR imaging in 10 volunteers. RESULTS: Overall, 101 CCAs and 79 ICAs were available for comparison. MR imaging underestimated (P < .05) systolic CCA and ICA blood flow velocity by 26% (0.79 ± 0.29 m/s vs 1.06 ± 0.31 m/s) and 19% (0.72 ± 0.21 m/s vs 0.89 ± 0.27 m/s) compared with US. Diastolic blood flow velocities were similar for MR imaging and US (differences, 9% and 3%, respectively; not significant). Reproducibility and interobserver agreement of 4D flow MR imaging was excellent. CONCLUSIONS: 4D flow MR imaging allowed for an accurate measurement of blood flow velocities in the carotid bifurcation of both volunteers and patients with only moderate underestimation compared with US. Thus, 4D flow MR imaging seems promising for a future combination with MRA to comprehensively assess ICA stenosis and related hemodynamic changes.

Efficient stem cell labeling for MRI studies.

Iron oxide particles are especially suited for cell tracking experiments due to their extraordinarily molar relaxivity as compared with other paramagnetic nuclei. We have compared different iron oxide particles (Sinerem, Endorem and magnetic microspheres) for their suitability to label embryonic stem cells (D3 cell line). In addition to detectability thresholds, particular attention has been paid to the evaluation of long-term stability of the labelling procedure (up to 4 weeks) as well as to toxic and other adverse effects on cell viability. Comparative studies were performed using neural progenitor cells (C17.2) and dendritic cells. The present study indicates strong dependence of the label efficiency and stability on the iron oxide particles and cell lines in use.

Reliability of aortic MRI at 3 Tesla in patients with acute cryptogenic stroke.

OBJECTIVES: To evaluate a new three dimensional (3D) MRI protocol for the reliable detection of aortic high risk plaques compared with transoesophageal echocardiography (TOE) and to test the reliability of additional MRI in stroke of undetermined aetiology. METHODS: 74 acute stroke patients were examined by both TOE and MRI at 3 Tesla with special regard to aortic high risk plaques (ie, > OR = 4 mm, superimposed thrombi). ECG synchronised pre- and post-contrast T1 weighted 3D imaging (spatial resolution approximately 1 mm3) covering the thoracic aorta was employed. In plaques > OR = 3 mm, additional two dimensional T2 imaging and time resolved (CINE) imaging sequences were performed. Aetiology of brain ischaemia was classified according to modified TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Aortic high risk embolic sources detected by MRI in patients with cryptogenic stroke were evaluated. RESULTS: Differences in maximum aortic wall thickness for TOE and MRI were not statistically significant for all aortic segments. The overall number of high risk plaques detected by MRI (n = 74) was substantially higher compared with TOE (n = 47). Most noticeably, MRI identified aortic high risk pathologies in 8/26 (30.8%) patients with cryptogenic stroke after standard diagnostics, including TOE (n = 2: dissection or thrombus; n = 6: plaques > OR = 4 mm). CONCLUSIONS: Our results demonstrate the feasibility of this 3D MRI protocol for the reliable detection of aortic high risk plaques in acute stroke patients. Because of improved visualisation of the aortic arch and the detection of additional embolic sources not seen by standard diagnostics, this novel technique may become a valuable tool for future patients with cryptogenic stroke.

Intoxicacion por endrin.Informe de 33 casos. / Endrin poisoning.Report of 33 cases

La intoxicacion por el raticida endrin en 33 pacientes pediatricos se caracterizo por crisis convulsivas de inicio brusco, sin aura o fenomenos sensoriales, que evolucionaron rapidamente al estado epileptico. El laboratorio no aporto datos de interes y el electroencefalograma en 15 pacientes informo activacion centroencefalica paroxistica importante sin asimetrias ni focalizaciones. En dos ninos que murieron la autopsia mostro edema y congestion cerebral con degeneracion neuronal extensa La exposicion al endrin esta propiciada por su venta libre y uso sin control en el hogar lo que definitivamente debe prohibirse dada su peligrosidad y por no existir tratamiento especifico para la intoxicacion

[Use of mannitol and dexamethasone in the management of acute cerebral edema of infectious origin]. / Uso de manitol y dexametasona en el manejo del edema cerebral agudo de origen infeccioso

The study included 22 patients with meningoencephalitis and hypertensive cranial syndrome from cerebral edema. Mannitol was given to 13 cases and dexamethasone to 9. There were three therapeutic failures in the group given mannitol and none in that of dexamethasone (p greater than 0.05). Both drugs showed similar effect in the duration of the hypertensive cranial syndrome (39-44 hrs). Patients treated with mannitol showed hyponatremia after 48 hours. No untoward effects appeared in patients given dexamethasone.