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1.
Radiol Clin North Am ; 57(6): 1083-1091, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582036

RESUMO

This article reviews the current state of imaging for acute ischemic stroke. Protocolized imaging acquisition using computed tomography in conjunction with coordinated stroke care allows for rapid diagnosis and prompt revascularization. Following the initial evidence to support endovascular therapy for large-vessel occlusion, published between 2014 and 2015, there are now guidelines supporting treatment up to 24 hours after time of onset of symptoms. Neuroimaging remains a central component in diagnosing acute stroke and potentially excluding patients from stroke treatment, as outlined in this article.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Humanos , Neuroimagem/métodos
2.
Radiol Clin North Am ; 57(6): 1093-1108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582037

RESUMO

Acute stroke is a leading cause of morbidity and mortality in the United States. Acute ischemic strokes have been classified according to The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system, and this system aids in proper management. Nearly every patient who presents to a hospital with acute stroke symptoms has some form of emergent imaging. As such, imaging plays an important role in early diagnosis and management. This article reviews the imaging patterns of acute strokes, and how the infarct pattern and imaging characteristics can suggest an underlying cause.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Humanos , Fatores de Risco , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem
3.
Radiol Clin North Am ; 57(6): 1109-1116, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582038

RESUMO

Occlusion of a cervical or cerebral artery may cause acute ischemic stroke (AIS). Recent advances in AIS treatment by endovascular thrombectomy have led to more widespread use of advanced computed tomography (CT) imaging, including perfusion CT (PCT). This article reviews PCT for the evaluation of AIS patients.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/complicações , Angiografia Cerebral , Humanos , Acidente Vascular Cerebral/complicações
4.
Ann Hematol ; 98(10): 2267-2271, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31388698

RESUMO

Silent brain lesions might be associated with overt cerebrovascular accident over time in beta thalassemia major (BTM) and intermediate (BTI). Aspirin may be protective in these patients. We evaluated brain magnetic resonance imaging (MRI) in thalassemia patients to see whether aspirin is protective or not. A historical cohort study was conducted on 35 thalassemia patients, 22 BTI, and 13 BTM patients at Shiraz Hematology Research Center in 2018. Median age of the patients was 32 years and ranged from 8 to 42 years. Twenty-four patients (68.6%) were females. Overall frequency of white matter lesions (WMLs) in the first MRI was 10 patients (28.6%). After 3 years, 3 patients developed new lesions and the frequency of WMLs was 13 patients (37.1%) in the second MRI. Moreover, in 3 patients, number of WMLs increased. Patients with new lesions or more lesions compared to the baseline were significantly older than the other group (median age 36.5 years vs. 31 years, P = 0.046). Regarding aspirin consumption, only 1 patient (16.7%) of patients with new lesions was using aspirin compared to 10 (34.5%) of the other group (P = 0.640). The high-risk patients with thrombocytosis, splenectomy, severe iron overload, and older age (> 30 years) should be under close follow-up and evaluated on a regular periodic basis as well as brain MRI at least once every 3 years. Aspirin could be protective against new or progressive brain lesions so that low-dose aspirin is recommended in high-risk thalassemia patients.


Assuntos
Aspirina/administração & dosagem , Imagem por Ressonância Magnética , Acidente Vascular Cerebral , Talassemia beta , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Talassemia beta/complicações , Talassemia beta/diagnóstico por imagem , Talassemia beta/tratamento farmacológico , Talassemia beta/epidemiologia
5.
Nervenarzt ; 90(10): 979-986, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31407046

RESUMO

Important milestones of acute ischemic stroke (AIS) treatment were achieved in recent years. The results of two randomized controlled trials revealed that intravenous thrombolysis is efficacious for treatment of AIS patients with a symptom onset <9 h or an unknown time of symptom onset in the presence of beneficial patterns in advanced stroke imaging. These patterns comprise the evidence of salvageable tissue at risk of infarction in perfusion of computed tomography (so-called penumbral imaging) or a mismatch between the diffusion-weighted imaging (DWI) und fluid-attenuated inversion recovery (FLAIR) sequences in magnetic resonance imaging (so-called DWI-FLAIR mismatch). Another two randomized controlled trials resulted in evidence of a high effectiveness of mechanical thrombectomy using advanced imaging of selected AIS patients with a symptom onset <24 h or an unknown time window. This article provides an overview of the current study results and recommendations for the selection of imaging for evidence-based effective acute treatment of stroke patients.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Terapia Trombolítica , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Imagem de Difusão por Ressonância Magnética , Fibrinolíticos/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
6.
Lancet ; 394(10203): 1022-1029, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31422895

RESUMO

BACKGROUND: In non-surgical settings, covert stroke is more common than overt stroke and is associated with cognitive decline. Although overt stroke occurs in less than 1% of adults after non-cardiac surgery and is associated with substantial morbidity, we know little about perioperative covert stroke. Therefore, our primary aim was to investigate the relationship between perioperative covert stroke (ie, an acute brain infarct detected on an MRI after non-cardiac surgery in a patient with no clinical stroke symptoms) and cognitive decline 1 year after surgery. METHODS: NeuroVISION was a prospective cohort study done in 12 academic centres in nine countries, in which we assessed patients aged 65 years or older who underwent inpatient, elective, non-cardiac surgery and had brain MRI after surgery. Two independent neuroradiology experts, masked to clinical data, assessed each MRI for acute brain infarction. Using multivariable regression, we explored the association between covert stroke and the primary outcome of cognitive decline, defined as a decrease of 2 points or more on the Montreal Cognitive Assessment from preoperative baseline to 1-year follow-up. Patients, health-care providers, and outcome adjudicators were masked to MRI results. FINDINGS: Between March 24, 2014, and July 21, 2017, of 1114 participants recruited to the study, 78 (7%; 95% CI 6-9) had a perioperative covert stroke. Among the patients who completed the 1-year follow-up, cognitive decline 1 year after surgery occurred in 29 (42%) of 69 participants who had a perioperative covert stroke and in 274 (29%) of 932 participants who did not have a perioperative covert stroke (adjusted odds ratio 1·98, 95% CI 1·22-3·20, absolute risk increase 13%; p=0·0055). Covert stroke was also associated with an increased risk of perioperative delirium (hazard ratio [HR] 2·24, 95% CI 1·06-4·73, absolute risk increase 6%; p=0·030) and overt stroke or transient ischaemic attack at 1-year follow-up (HR 4·13, 1·14-14·99, absolute risk increase 3%; p=0·019). INTERPRETATION: Perioperative covert stroke is associated with an increased risk of cognitive decline 1 year after non-cardiac surgery, and perioperative covert stroke occurred in one in 14 patients aged 65 years and older undergoing non-cardiac surgery. Research is needed to establish prevention and management strategies for perioperative covert stroke. FUNDING: Canadian Institutes of Health Research; The Ontario Strategy for Patient Oriented Research support unit; The Ontario Ministry of Health and Long-Term Care; Health and Medical Research Fund, Government of the Hong Kong Special Administrative Region, China; and The Neurological Foundation of New Zealand.


Assuntos
Disfunção Cognitiva/etiologia , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Disfunção Cognitiva/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Delírio do Despertar/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
7.
Medicine (Baltimore) ; 98(30): e16360, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348236

RESUMO

BACKGROUND AND OBJECTIVE: Ischemic stroke is a foremost cause for disability and death worldwide. This study is conducted in order to compare the diagnostic values between transcranial Doppler ultrasound (ultrasonography), computed tomography (CT), and magnetic resonance imaging (MRI) in patients suffering from ischemic stroke by performing a network meta-analysis. METHODS: We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the seven different imaging methods. These imaging techniques include ultrasonography, computed tomography (traditional CT, computed tomography angiography [CTA], computed tomography perfusion [CTP]), and MRI (traditional MRI, diffusion-weighted imaging [DWI], magnetic resonance angiography), in order to properly diagnose ischemic stroke patients. RESULTS: Thirteen eligible diagnostic trials were enrolled into this network meta-analysis. The results of the traditional meta-analysis showed that among CT methods, CTP showed higher sensitivity, NPV, and accuracy; among MRI methods, DWI had relatively higher sensitivity, NPV, and accuracy. The results of network meta-analysis showed that DWI had relatively higher sensitivity, NPV, and accuracy when compared with traditional CT, CTA, magnetic resonance angiography and traditional MRI. CTP showed higher SUCRA among CT methods while DWI showed higher SUCRA among MRI methods. A cluster analysis revealed that DWI had the highest diagnostic value in terms of sensitivity, PPV, NPV, and accuracy amongst the aforementioned seven imaging techniques. CONCLUSION: This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler Transcraniana/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/normas , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Difusão por Ressonância Magnética/normas , Humanos , Angiografia por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/normas , Imagem por Ressonância Magnética/normas , Meta-Análise em Rede , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/normas , Ultrassonografia Doppler Transcraniana/normas
8.
Medicine (Baltimore) ; 98(26): e16212, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261574

RESUMO

Patients with severe stroke and salvageable brain tissue at admission, who have higher glycaemic and blood pressure levels, may have a risk of iatrogenic hypoglycemia/iatrogenic hypotension. In this study, we examined the relationship between the presence of diffusion-weighted imaging (DWI)/perfusion-weighted imaging (PWI) mismatch, admission blood glucose level, and admission blood pressure level in patients who were admitted in the first 12 hours after onset. We studied 212 patients who were prospectively and consecutively registered to the stroke unit from 2006 to 2009. Correlations between mismatch and admission blood pressure level (ABPL) and admission blood glucose level (ABGL) were analyzed using multivariate logistic regression. Mismatch (P = .064, adjusted OR = 2.297, 95% CI, 0.953-5.536) was not associated with a high ABGL in the whole group. However, after excluding patients with diabetes mellitus (DM) (n = 67, 35%), mismatch (P = .033, adjusted OR = 3.801, 95% CI, 1.110-13.015), an impaired level of consciousness, use of anti-DM medication, glycated hemoglobin levels, and cardioembolic aetiology were independent predictors of a high ABGL. The presence of mismatch or proximal vessel occlusion was not associated with ABPL. Female sex (P = .048) and total anterior circulation stroke (P = .008) were independent predictors associated with a higher ABPL. We conclude that patients with hyperacute ischemic stroke with PWI/DWI mismatch are more likely to have hyperglycemia.


Assuntos
Imagem de Difusão por Ressonância Magnética , Angiografia por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Glicemia , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Prospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/fisiopatologia
9.
Soins Gerontol ; 24(138): 17-19, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31307684

RESUMO

Giant cell arteritis (GCA) is associated with an increased risk of cardio- or cerebro-vascular death. The stroke rate in patients with GCA varies between 2.7 and 7.4%. The etiological diagnosis may be challenging between atherosclerotic stroke and stroke related to GCA. Case of an old woman who had ischemic stroke and concomitant diagnosis of GCA and brain imaging characteristics.


Assuntos
Arterite de Células Gigantes/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Feminino , Humanos
10.
J Craniofac Surg ; 30(5): e388-e392, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299787

RESUMO

OBJECTIVES: We investigated unilateral and bilateral cervical internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST). METHODS: We retrospectively investigated ICA stenosis on Head&Neck Computed Tomography Angiography (CTA); and their simultaneous brain computed tomography images were also evaluated. In unilateral ICA stenosis group (n=36), 17 of them had right ICA stenosis and 19 left ICA stenosis. In bilateral stenosis group, there were 24 patients. ICA stenosis was evaluated according to NASCET and ECST methods. We also evaluated vertebral artery dimension, plaque density and cerebral infarct (Cerebral kortex, white matter, basal ganglion-thalamus). RESULTS: Unilateral ICA stenosis according to the NASCET was 70.64% to 73.68% (right-left) and according to the ECTS was 65.52% to 71.15% (right-left). For bilateral stenosis, ICA stenosis according to the NASCET was 67.70 to 67.91 (right-left); according to the ECTS was 62.45% to 62.15% (right-left). Vertebral artery dimensions were 3.26 to 3.72 mm (right-left) in unilateral ICA stenosis; and 3.52 to 3.71 mm (right-left) in bilateral ICA stenosis. In bilateral stenosis group, mixt plaque; and in unilateral stenosis group, hard plaque was detected. In unilateral stenosis, white matter and basal ganglion-thalamus infarcts; in bilateral ICA stenosis, cerebral cortical infarct was detected. Left-vertebral artery diameter increased in higher L-ECTS ICA stenosis (unilateral) group. CONCLUSION: Increase in left vertebral artery diameter in unilateral L-ECTS ICA stenosis may be related to increase of the collateral flow by vertebral arteries to support brain blood-flow.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Angiografia por Tomografia Computadorizada , Constrição Patológica , Endarterectomia das Carótidas , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Artéria Vertebral
11.
J Stroke Cerebrovasc Dis ; 28(9): 2481-2487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31277996

RESUMO

The Goal: The aim of the study was to investigate whether stroke volume or the presence of ischemic stroke lesion on follow-up computed tomography 1 day after admission had association with sleep apnea among ischemic stroke patients undergoing thrombolysis. MATERIALS AND METHODS: We prospectively recruited 110 consecutive ischemic stroke patients and performed computed tomography on admission and after 24 hours after intravenous thrombolysis. Stroke volume was measured from post-thrombolysis computed tomography scans. Unattended cardiorespiratory polygraphy with a 3-channel device was performed during 48 hours after admission. FINDINGS: Of 110 ischemic stroke patients treated with thrombolysis 65.5% were men. Mean age was 65.8 years and body mass index 27.5 kg/m2. The mean Epworth sleepiness scale score was 4.7. Eight patients (12.7%) with visible acute stroke after thrombolysis and none in the other group had hemorrhage as complication (P ˂ .001). Sleep apnea, determined as a respiratory event index greater than or equal to 5/hour, was diagnosed in 96.4% patients. Respiratory event index greater than 15/h was found in 72.8% of patients. Both mean baseline oxygen desaturation index (23.9 versus 16.5, P = .028) and obstructive apneas/hour (6.2 versus 2.7, P = .007) were higher in visible stroke group. Stroke volume (mean 15.9 mL) correlated with proportion of time spent below saturation less than 90%, P = .025. CONCLUSIONS: Acute ischemic stroke patients treated with thrombolysis with visible stroke were more likely to have nocturnal hypoxemia than patients with not visible strokes. Stroke volume correlated with time spent below saturation of 90%.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hipóxia/etiologia , Síndromes da Apneia do Sono/etiologia , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Infusões Intravenosas , Pulmão/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração , Fatores de Risco , Sono , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Stroke Cerebrovasc Dis ; 28(9): 2530-2536, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307897

RESUMO

BACKGROUND: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. METHODS/RESULTS: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. DISCUSSION/CONCLUSIONS: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.


Assuntos
Ambulâncias/organização & administração , Diagnóstico por Computador , Registros Eletrônicos de Saúde/organização & administração , Unidades Móveis de Saúde/organização & administração , Acidente Vascular Cerebral/diagnóstico por imagem , Integração de Sistemas , Telerradiologia/organização & administração , Tomografia Computadorizada por Raios X , Tecnologia sem Fio/organização & administração , Colorado , Prestação Integrada de Cuidados de Saúde/organização & administração , Diagnóstico por Computador/instrumentação , Humanos , Valor Preditivo dos Testes , Prognóstico , Avaliação de Programas e Projetos de Saúde , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Telerradiologia/instrumentação , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/instrumentação , Tecnologia sem Fio/instrumentação , Fluxo de Trabalho
13.
Stud Health Technol Inform ; 262: 312-315, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349330

RESUMO

Identifying imaging biomarkers (IBs) of stroke remains a priority in neurodiagnostics. There is a number of different methods for image analysis and learning rules applicable in this field, but all of them require large arrays of DICOM images and clinical data. In order to amass such dataset,we havedesigneda platform for systematic collection of clinical data and medical images in different modalities. The platform provides easy-to-use tools to create formalized radiology reports, contour and tag the regions of interest (ROIs) on the DICOM images, and extract radiomics data. Subsequent analysis of the obtained data will allow identifying the most relevant IBs that predict clinical outcome and possible complications. The results of the analysis will be used to develop predictive algorithms for stroke diagnostics.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador , Acidente Vascular Cerebral , Biomarcadores , Coleta de Dados , Humanos , Software , Acidente Vascular Cerebral/diagnóstico por imagem
14.
Medicine (Baltimore) ; 98(23): e15775, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169676

RESUMO

The relationship between the left arcuate fasciculus (AF) and stroke-related aphasia is unclear. In this retrospective study, we aimed to investigate the role of subcomponents of the left AF in predicting prognosis of aphasia after stroke. Twenty stroke patients with aphasia were recruited and received language assessment as well as diffusion tensor tractography scanning at admission. According to injury of the left AF, the participants were classified into four groups: group A (4 cases), the AF preserved intactly; group B (6 cases), the anterior segment injured; group C (4 cases), the posterior segment injured; and group D (6 cases), completely injured. After a consecutive speech therapy, language assessment was performed again. Changes of language functions among the groups were compared and the relation between these changes with segments injury of the AF was analyzed. After therapy, relatively high increase score percentage changes in terms of all the subcategories of language assessment were observed both in group A and C; by contrast, only naming in group B, and spontaneous speech in group D. Although no statistical difference was demonstrated among the four groups. In addition, there was no significant correlation between improvement of language function with segments injury of the AF. The predictive role of subcomponents of the left AF in prognosis of aphasia is obscure in our study. Nevertheless, it indicates the importance of integrity of the left AF for recovery of aphasia, namely that preservation of the left AF on diffusion tensor tractography could mean recovery potential of aphasia after stroke.


Assuntos
Afasia/diagnóstico por imagem , Imagem de Tensor de Difusão/estatística & dados numéricos , Via Perfurante/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Afasia/etiologia , Afasia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Via Perfurante/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fala , Fonoterapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral
15.
Eur J Radiol ; 116: 219-224, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153569

RESUMO

BACKGROUND: Endovascular treatment is considered a reasonable approach for patients with acute posterior circulation stroke, but it remains uncertain which patients will benefit the most from it. OBJECTIVE: To find independent clinical and angiographic predictors of outcome after endovascular treatment for posterior circulation stroke. METHODS: We evaluated consecutive patients with acute posterior circulation stroke who underwent endovascular treatment in our comprehensive stroke center from January 2015 to December 2017. Good outcome was defined as a modified Rankin score of 0-3 at 90 days. Intracranial atheromatous disease was established on focal stenosis recorded during endovascular treatment. Associations were sought between a good outcome and clinical and angiographic factors. Adjusted logistic regression models were used to define independent outcome predictors. RESULTS: Forty-seven consecutive patients were included: mean age 70.9 ± 12.1 years, median admission NIHSS score, 16 (IQR: 8-30). On univariate analysis, age (p = 0.01), smoking (p = 0.04), hypertension (p = 0.03), successful reperfusion (p = 0.04), presence of extracranial atherosclerosis (p = 0.02), and absence of atherosclerosis (p = 0.03) were significantly associated with a good outcome. On multivariate analysis, age <70 years (odds ratio = 6.20, 95%CI 1.52-25.47, p = 0.01) and absence of intracranial atherosclerosis (odds ratio = 6.45, 95% CI 1.09-38.24, p = 0.04) were independently associated with a good outcome. CONCLUSIONS: Pretreatment determination of the presence or absence of intracranial atherosclerosis can aid management of posterior circulation stroke patients. The absence of intracranial atherosclerosis may have value as a positive selection criterion for endovascular treatment in future trials. The presence of intracranial atherosclerosis could be used as a selection tool in future studies investigating new treatment protocols for this population.


Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares/métodos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Angiografia Cerebral/métodos , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/fisiopatologia , Arteriosclerose Intracraniana/terapia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neuroimagem/métodos , Razão de Chances , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Trombectomia/métodos , Terapia Trombolítica/métodos , Resultado do Tratamento
16.
Radiologe ; 59(6): 541-549, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31197399

RESUMO

CLINICAL ISSUE: The intravenous administration of contrast agents increases the contrast between diverse tissues and vessels against their surroundings in both computed tomography (CT) and magnetic resonance imaging (MRI) scans and has been generously used for years. There are only a few scientific publications that have systematically evaluated the impact of this contrast-enhancing technique over noncontrast enhancing techniques. RADIOLOGICAL STANDARD: According to these publications and our clinical experiences, there are far more indications to use non-contrast-enhancing techniques as they are used in clinical practice. The most important requirement to renounce the use of a contrast agent is sufficient clinical information and differentiated justified indication. The present review shows useful non-contrast-enhanced examination techniques for neuroradiology, musculoskeletal system, lymphatic system, and thorax, including the hearth, abdomen and breasts. CLINICAL RECOMMENDATIONS: Good indications for non-contrast imaging are generally follow-ups. In cerebral related questions, like in traumatic or atraumatic emergencies, transient ischemic attacks, minor stroke diagnostic, dementia and in follow-ups of multiple sclerosis, there is usually no need for contrast agent. Examinations of the musculoskeletal systems and follow-up examinations of the lymphatic system can generally be done without a contrast agent. There is no major loss of value in CT and MRI scans of the thorax by examining without contrast. The value of using a contrast agent in the abdomen is far less than expected. Up to now use of a contrast agent is essential in evaluating questions related to vessels or angiomatous tissue and in breast MRI.


Assuntos
Imagem por Ressonância Magnética , Acidente Vascular Cerebral , Tomografia Computadorizada por Raios X , Meios de Contraste , Humanos , Radiografia , Acidente Vascular Cerebral/diagnóstico por imagem
17.
Int J Nanomedicine ; 14: 3571-3582, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213799

RESUMO

Background: In vivo fluorescence imaging in the second near-infrared (NIR-II, 1000-1700 nm) window using organic fluorophores has great advantages, but generally suffers from a relatively low fluorescence quantum yield (mostly less than 2%). In this study, organic nanoparticles (L1013 NPs) with a high fluorescence quantum yield (9.9%) were systhesized for in vivo imaging. Methods: A molecule (BTPPA) with donor-acceptor-donor structure and aggregation-induced emission enabling moieties was prepared. BTPPA molecules were then encapsulated into nanoparticles (L1013 NPs) using a nanoprecipitation method. The L1013 NPs were intravenously injected into the mice (including normal, stroke and tumor models) for vascular and tumor imaging. Results: L1013 NPs excited at 808 nm exhibit NIR-II emission with a peak at 1013 nm and an emission tail extending to 1400 nm. They have a quantum yield of 9.9% and also show excellent photo/colloidal stabilities and negligible in vitro and in vivo toxicity. We use L1013 NPs for noninvasive real-time visualization of mouse hindlimb and cerebral vessels (including stroke pathology) under a very low power density (4.6-40 mW cm‒2) and short exposure time (40-100 ms). Moreover, L1013 NPs are able to localize tumor pathology, with a tumor-to-normal tissue ratio of 11.7±1.3, which is unusually high for NIR-II fluorescent imaging through passive targeting strategy. Conclusion: L1013 NPs demonstrate the potential for a range of clinical applications, especially for tumor surgery.


Assuntos
Corantes Fluorescentes/química , Nanopartículas/química , Imagem Óptica/métodos , Espectroscopia de Luz Próxima ao Infravermelho , Animais , Vasos Sanguíneos/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Modelos Animais de Doenças , Transferência Ressonante de Energia de Fluorescência , Corantes Fluorescentes/síntese química , Corantes Fluorescentes/farmacocinética , Camundongos Endogâmicos C57BL , Nanopartículas/toxicidade , Nanopartículas/ultraestrutura , Acidente Vascular Cerebral/diagnóstico por imagem , Distribuição Tecidual
18.
Radiologe ; 59(7): 603-609, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31161301

RESUMO

PURPOSE OF IMAGING: Imaging plays a major role in the diagnosiss, treatment indication, and prognosis of acute ischemic stroke. RECENT STUDY RESULTS: Recent studies have proved the safety and effectiveness of thrombolysis and endovascular thrombectomy based on the individual combination of imaging and patients clinical information even beyond the classical time-windows. In these cases, magnetic resonance imaging and perfusion-imaging can provide additional and important information. STANDARD DIAGNOSTICS: Nevertheless, computed tomography with and without contrast media still represents the most available and fastest method to diagnose stroke.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Imagem de Perfusão , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia , Resultado do Tratamento
19.
Radiologe ; 59(7): 627-631, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31201515

RESUMO

Diffusion-weighted imaging enables us to detect acute ischemic stroke early and with high sensitivity and specificity. Its signal changes are based on decreased diffusion of water molecules that is caused by cytotoxic edema. Several different neurological diseases can also cause restricted diffusion and therefore mimic stroke. These can generally be reliably distinguished from ischemic stroke based on location, morphology and signal behavior in other magnetic resonance imaging sequences.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Humanos , Imagem por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Artigo em Russo | MEDLINE | ID: mdl-31156226

RESUMO

The diagnosis of acute stroke should be correct and early that allows physician planning the most effective treatment strategies (reperfusion therapy, undifferentiated (basic) treatment, early secondary prevention). However, stroke symptoms can be atypical and similar to some other (non-vascular) event. It can significantly complicate the clinical diagnosis of stroke and decrease the patient's chances for effective treatment. A stroke should be suspected in every patient with acute onset of neurological symptoms, especially when the patient has the 'vascular' risk factors. Furthermore it is important to remember that negative CT-scan data and/or MRI data do not exclude the presence of not only ischemic stroke but also hemorrhagic stroke. The article describes the main variants of strokes with atypical symptoms (strokes-chameleons), emphasizes the importance of careful clinical examination, provides supportive differential diagnostic criteria and discusses limitations of neuroimaging methods.


Assuntos
Acidente Vascular Cerebral , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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