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1.
Zhonghua Yi Xue Za Zhi ; 99(47): 3725-3731, 2019 Dec 17.
Artigo em Chinês | MEDLINE | ID: mdl-31874498

RESUMO

Objective: To investigate the clinical value of magnetic resonance (MR) intravoxel incoherent motion (IVIM) diffusion imaging and 3D pseudo continuous arterial spin labeling (3D-pcASL) perfusion imaging in the evaluation of acute cerebral infarction. Methods: MR images of 49 patients with unilateral acute cerebral infarction diagnosed and treated in Affiliated Yancheng Hospital of Southeast University Medical College from October 2015 to February 2019 were retrospectively analyzed. High signal infarction area (S(D)) on diffusion image slice with the biggest lesion level and abnormal perfusion area (S(CBF)) on the corresponding level were measured. The presence of ischemic penumbra (IP) was represented by S(CBF)> S(D), and patients were divided into group IP and group non-IP. Regions of interest were set on the infarction core, brain tissue near the edge of the lesion (BNL) and their corresponding contralateral regions. The values of apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion related diffusion coefficient (D(*)), perfusion fraction (f) and cerebral blood flow (CBF) of each region of interest were recorded and relative values of infarction lesion to its contralateral region (rADC, rD, rD(*), rf, rCBF) were calculated. Differences of each parameter value between infarction core, BNL and their corresponding contralateral regions and of each relative parameter value between infarction core and BNL, and between the two groups were compared.The differential diagnostic efficacy of relative parameter value with differences between groups was analyzed by receiver operating characteristics (ROC) curve. The correlations of each relative parameter value of 3D-pcASL and IVIM sequences were analyzed. Results: The ADC, D, f and CBF values of infarction core were significantly lower than those of contralateral regions in both groups (all P<0.01). Among all parameters of BNL in both groups, only the CBF value of group IP was significantly lower than that of contralateral region ((27.58±3.53) vs (41.20±5.66) ml·100 g(-1)·min(-1), P<0.01). The rADC, rD, rf and rCBF of infarction core were significantly lower than those of BNL in both groups (all P<0.01). The rCBF of BNL in group IP was significantly lower than that in group non-IP (0.68±0.12 vs 0.97±0.15, P<0.01), and the area under the curve was 0.949, the optimal threshold was 0.823, and the youden index was 0.855 for identifying the two groups. Other relative parameters values of infarction core and BNL had no statistical difference between the two groups. There were positive correlations between rCBF and rADC, rD, rf (r=0.428,0.335,0.565) of infarction core, rADC and rD, rf (r=0.853,0.602) of infarction core, also rADC and rD (r=0.336) of BNL (all P<0.05). Conclusions: IVIM can effectively evaluate the difusion and perfusion information of acute cerebral infarction lesions. However, its perfusion related parameters are not as good as 3D-pcASL in IP evaluation, which should be flexibly selected according to the actual needs of patients' condition evaluation.


Assuntos
Isquemia Encefálica , Isquemia Encefálica/diagnóstico por imagem , Infarto Cerebral , Imagem de Difusão por Ressonância Magnética , Humanos , Movimento (Física) , Imagem de Perfusão , Estudos Retrospectivos , Marcadores de Spin
2.
Medicina (B Aires) ; 79 Suppl 3: 10-14, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31603836

RESUMO

Preterm birth is one of the main country health indicators. It is associated with high mortality and significant morbidity in preterm newborns with cerebral palsy and potential long-term neurodevelopmental disabilities like cognitive and learning problems. The main lesions could be: a) white matter injuries, generally associated with cortical and other regions of grey matter neuronal-axonal disturbances; b) intracranial hemorrhage that includes germinal matrix, intraventricular and parenchymal, c) cerebellum injuries. The white matter lesions include cystic and non-cystic (with microscopic focal necrosis) periventricular leukomalacia and non-necrotic diffuse white matter injury. Multiple etiologic factors are associated with these injuries. Anatomical and physiological characteristics of periventricular vascular structures predispose white matter to cerebral ischemia and, interacting with infection/inflammation factors, activate microglia, generating oxidative stress (mediated by free oxygen and nitrogen radicals), pro-inflammatory cytokine and glutamate toxicity, energetic failure and vascular integrity disturbances. All these factors lead to a particular vulnerability of pre-oligodendrocytes that will affect myelination. Hypoxia-ischemia also may produce selective neuronal necrosis in different cerebral regions. Germinal matrix is a highly vascularized zone beneath ependymal or periventricular region that constitutes a capillary bed with a particular structural fragility that predispose it to hemorrhage.


Assuntos
Lesões Encefálicas/etiologia , Isquemia Encefálica/etiologia , Paralisia Cerebral/etiologia , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido Prematuro , Leucomalácia Periventricular/etiologia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/mortalidade , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Paralisia Cerebral/mortalidade , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/mortalidade , Recém-Nascido , Leucomalácia Periventricular/diagnóstico por imagem , Leucomalácia Periventricular/mortalidade , Substância Branca/patologia
3.
Zhonghua Yi Xue Za Zhi ; 99(37): 2943-2946, 2019 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-31607027

RESUMO

Objective: To acquire the signal of neuron excitability and blood oxygen in mouse cortex after ischemic stroke, and to clarify the relationship between the change of neurovascular function and the degree of cerebral infarction. Methods: The male C57BL/6 mouse(n=20) about 6-8 weeks and 20 g weight were produced the embolic stroke modal by photochemical injury. The mouse cortex was scanned by the multispectral optical imaging while using electric stimulation in 1, 3 and 7 d after operation. Then several data around the infarction were acquired including neuron excitability, the total hemoglobin concentration and deoxygenated hemoglobin concentration. The ischemic cerebral infarction size was analyzed by TTC staining. Plasma TNF-α concentration was measured by enzyme-linked immunosorbent assay(ELISA). And modified neurological severity score (mNSS) was recorded after ischemic stroke(n=30). Then correlativity analysis was used between the optical signals and three indicators of cerebral infarction degree. Results: The changes of neuron excitability signals were 1.15%±0.28%, 2.84%±1.06%, 2.21%±0.55%. The total hemoglobin concentration signals were 3.71%±2.76%,3.19%±2.70%,4.27%±3.05%. The deoxygenated hemoglobin concentration signals were 2.93%±2.33%, 3.60%±1.74%, 2.08%±1.28%. The neural signal was correlated to cerebral infarction size, plasma TNF-α concentration and mNSS(r=-0.441, -0.449,-0.404, all P<0.05), and mNSS had a great effect on neuron excitability(ß=-0.169,P<0.05). Meanwhile, the total hemoglobin concentration was correlated to cerebral infarction size(r=0.440,P<0.05). Conclusion: The signal of neuron and blood oxygen is able to represent the change of neurovascular function and evaluate the progression of ischemic stroke.


Assuntos
Isquemia Encefálica , Infarto Cerebral , Infarto da Artéria Cerebral Média , Acidente Vascular Cerebral , Animais , Isquemia Encefálica/diagnóstico por imagem , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Acidente Vascular Cerebral/diagnóstico por imagem
4.
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
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.
Artigo em Russo | MEDLINE | ID: mdl-31339494

RESUMO

Prognosing the outcome of cerebral ischemia in the acute SAH phase still remains the topical issue for clinical practice because this largely affects the choice of an optimal timing of aneurysm clipping. The traditional criteria are often not effective enough to predict changes in cerebral ischemia, especially in patients in a compensated or subcompensated state who often develop delayed ischemia, which may lead to serious complications. The introduction of a CT perfusion technique for evaluating the volumetric cerebral blood flow stimulated the development of a new stage in investigation of cerebral ischemia in non-traumatic SAH. PURPOSE: The study purpose was to evaluate the significance of cerebral blood flow indicators obtained by CT perfusion for prediction of delayed cerebral ischemia and postoperative ischemic complications to optimize treatment of patients with ruptures of intracranial arterial aneurysms. MATERIAL AND METHODS: The study included 70 patients who underwent aneurysm clipping and 42 non-operated patients. The inclusion criteria were as follows: WFNS grade I-III condition, vasospasm according to transcranial Doppler sonography, and availability of CT scans, including CT perfusion data. The vasospasm severity and perfusion indicators _(rCBV and MTT) were evaluated. The severity of subarachnoid and ventricular hemorrhage was evaluated according to the A. Hijdra method. The final results were evaluated using a clinical-statistical method, including ROC analysis. RESULTS: An analysis of the obtained data revealed that the risk of delayed cerebral ischemia and postoperative ischemia increases significantly if the baseline hemispheric CBF value is below a threshold of 40 ml/100 g/min, and the baseline MMT indicator is above a threshold of 5 s. There was asymmetry of these CT perfusion indicators due to a larger deviation from the threshold values in the homolateral hemisphere compared to the opposite side. The ROC analysis results demonstrated diagnostic sensitivity and diagnostic specificity of the CT perfusion technique. CONCLUSION: The CT perfusion data together with the SAH severity and localization indicators may be used as predictors for the cerebral ischemia outcome in choosing the optimal timing of aneurysm clipping during the acute SAH period in patients in a WFNS grade I-III condition and with signs of mild or moderate vasospasm.


Assuntos
Isquemia Encefálica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Tomografia Computadorizada por Raios X , Vasoespasmo Intracraniano , Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasoespasmo Intracraniano/diagnóstico por imagem
7.
Emerg Med Clin North Am ; 37(3): 365-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262409

RESUMO

Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Encéfalo/diagnóstico por imagem , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Medicina de Emergência , Procedimentos Endovasculares , Febre/prevenção & controle , Fibrinolíticos/uso terapêutico , Humanos , Hipertensão/terapia , Oxigenoterapia , Transferência de Pacientes , Telemedicina , Tenecteplase/uso terapêutico , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico
8.
BMC Neurol ; 19(1): 158, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296184

RESUMO

BACKGROUND: Almost all case reports related to persistent trigeminal artery indicated that the existence of persistent trigeminal artery may increase the risk of ischemic stroke. However our case demonstrated that the persistent trigeminal artery may also play a protective role in preventing severe ischemic stroke by functioning as collateral circulation. CASE PRESENTATION: We reported a patient with left internal carotid artery occlusion with persistent trigeminal artery manifesting only as a minor acute ischemia stroke exhibiting acute onset of dizziness and difficulty in walking. Brain MRI showed two small areas of restricted diffusion on diffusion-weighted imaging in the left hemisphere. The digital subtraction angiography showed his left middle cerebral artery and bilateral anterior cerebral artery were supplied by the basilar artery via a persistent trigeminal artery. Furthermore, CT perfusion showed no remarkable difference between the two hemispheres. CONCLUSIONS: Persistent trigeminal artery may have a protective role in the setting of an acquired occlusion of homolateral internal carotid artery. Therefore, it is important to fully assess the presence of the persistent trigeminal artery in acute ischemic stroke.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Circulação Cerebrovascular , Circulação Colateral , Acidente Vascular Cerebral/diagnóstico por imagem , Variação Anatômica , Angiografia Digital , Arteriopatias Oclusivas , Anastomose Arteriovenosa/diagnóstico por imagem , Anastomose Arteriovenosa/fisiologia , Artéria Basilar/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Doenças das Artérias Carótidas , Artéria Carótida Interna/fisiopatologia , Angiografia Cerebral , Imagem de Difusão por Ressonância Magnética , Humanos , Isquemia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média , Acidente Vascular Cerebral/fisiopatologia
9.
Int J Evid Based Healthc ; 17 Suppl 1: S53-S56, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31283583

RESUMO

Stroke is one of the leading causes of mortality and the leading cause of functional impairment and cognitive deficits worldwide. It is important that clinical practice guidelines development is based on robust statistical and epidemiological data and their analysis throughout the whole process of guidelines development and implementation. The aim of this short communication is to analyse epidemiology of prevalence and incidence of ischaemic stroke, its main causes, brain imaging using MRI, recanalization therapies, secondary prevention with antiplatelet and anticoagulants, mortality data and to inform development of stroke clinical practice guidelines in the Czech Republic. The main analysed diagnosis was I63 (cerebral infarction) and secondary diagnoses were: I48 (atrial fibrillation and flutter), I35.9 (nonspecified aortic valve disease), Q21.1 (atrial septal defect) or I33.0 (acute and subacute endocarditis). We have also analysed use of brain imaging with MRI, recanalization treatment using intravenous thrombolysis and mechanical thrombectomy, stroke secondary prevention with antiplatelet drugs and anticoagulation as well as hospital admissions and mortality. In total, 159 344 patients were diagnosed with an ischaemic stroke from 2015 to 2017. Average prevalence of ischaemic stroke in the Czech Republic is 54.9 patients per 100 000. 22.2% of patients with stroke received intravenous thrombolysis or mechanical thrombectomy in 2017.


Assuntos
Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Anticoagulantes/administração & dosagem , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , República Tcheca/epidemiologia , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Prevalência , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/estatística & dados numéricos
10.
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
11.
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
12.
J Craniofac Surg ; 30(5): e424-e428, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299801

RESUMO

Eagle syndrome (ES) is a rare symptomatic condition generally caused by abnormal elongation of the styloid process or calcification of stylo-hyoid ligament.Patients with ES typically present a variety of symptoms, which range from mild discomfort to acute neurologic and referred pain in head-and-neck region.Eagle syndrome could be identified through physical examination but often goes undetected in the absence of imaging studies.Although uncommon, it should be considered in the differential diagnosis in patients with cervico-facial pain.The authors report 3 cases with clinical evidence of ES, including both neurologic and vascular patterns, with a clinical and radiological diagnosis.The authors also propose a brief review of its main clinical presentations, diagnostic studies, and part of treatment options of the syndrome.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Dor Facial/etiologia , Ossificação Heterotópica/etiologia , Osso Temporal/anormalidades , Adulto , Isquemia Encefálica/complicações , Infarto Cerebral/complicações , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Radiografia , Adulto Jovem
13.
J Stroke Cerebrovasc Dis ; 28(8): 2318-2323, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31200962

RESUMO

BACKGROUND: Detection of large vessel occlusion (LVO) is required for endovascular therapy in acute ischemic stroke (AIS) but CT angiography (CTA) is not always performed at primary stroke centers. Eye deviation on CT brain has been associated with improved stroke detection, but comparisons with angiographic status have been limited. This study sought to determine if radiological eye deviation was associated with LVO. METHODS: All AIS patients given intravenous thrombolysis who had acute CTA performed in 2 stroke units were reviewed over 2013-2015 for the presence of LVO. Eye deviation was determined by 2 clinicians blinded to LVO status. Logistic regression was performed to determine which factors predicated LVO. RESULTS: Total 195 AIS patients with acute CTA were identified; 124 (64%) had LVO. Median age was 72 (IQR 64-82) years, median National Institutes of Health Stroke Scale (NIHSS) was 12 (IQR 7-14). LVO patients had a higher NIHSS (15 versus 7, p < .01) and were more likely to have eye deviation on CT brain (71% versus 22.5%, p < .01). Logistic regression confirmed NIHSS score and eye deviation were associated with LVO, with odds ratios of 1.15 (per point) and 5.13 respectively. NIHSS less than equal to 11 gave greatest sensitivity (78.5%) and specificity (76.1%) for LVO with a positive predictive value of 84.7%. Eye deviation was similar with sensitivity 71%, specificity 77.5%, and 84.6%. CONCLUSIONS: Eye deviation on CT brain is strongly associated with LVO. Presence of eye deviation on CT should alert clinicians to probability of LVO and for formal angiographic testing if not already performed.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Movimentos Oculares , Olho/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Olho/fisiopatologia , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica , Reino Unido
14.
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
15.
J Stroke Cerebrovasc Dis ; 28(8): e123-e125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230823

RESUMO

Ischemic stroke is one of the most common complications of infective endocarditis (IE). IE must be considered as one of the causes of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), but early diagnosis of IE is difficult. AIS with ELVO must be treated using endovascular thrombectomy (EVT), with or without intravenous thrombolysis (IVT). IVT for AIS due to IE is not well established and remains controversial because of the risk of intracranial hemorrhage. A 42-year-old man suffered from right hemiparesis and disorientation, and AIS with ELVO was diagnosed. EVT with IVT was successfully performed and recanalization was achieved, but catastrophic multiple cerebral microbleeds appeared after treatment. EVT without IVT could be chosen for AIS caused by IE to avoid hemorrhagic complications. Hypointense signal spots on T2*-weighted magnetic resonance imaging (MRI) and susceptibility-weighted MRI could facilitate early diagnosis of IE.


Assuntos
Isquemia Encefálica/terapia , Endocardite Bacteriana/complicações , Procedimentos Endovasculares/efeitos adversos , Hemorragias Intracranianas/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Angiografia Cerebral/métodos , Imagem de Difusão por Ressonância Magnética , Endocardite Bacteriana/diagnóstico , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 28(9): 2580-2584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239221

RESUMO

BACKGROUND: Pulse wave velocity is commonly regarded as the most effective and noninvasive indicator for evaluating arterial stiffness, while increased arterial stiffness is known to be related to atherosclerosis, which has been proved to play a significant role on the onset of acute ischemic stroke. However, it is still only used in the assessment of central and peripheral arteries. Our previous studies have found that carotid-cerebral pulse wave velocity measured using transcranial Doppler may be a promising method for the assessment of human cerebral arterial stiffness. This trial was designed to examine the association between carotid-cerebral pulse wave velocity and acute ischemic stroke. METHODS: In a single-center, single-arm, prospective clinical trial, patients with acute ischemic stroke who had anterior circulation infarcts confirmed by magnetic resonance imaging are eligible to receive measurement of carotid-cerebral pulse wave velocity, which is measured in the supine position with transcranial Doppler that using 2-MHz and 4-MHz ultrasound probes by 2 experienced operators. Subjects will be received follow-up for 1 year. Vascular and nonvascular death at follow-up will be assessed as primary outcomes. Secondary outcomes include intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack, recurrence or aggravation of ischemic stroke. CONCLUSION: This trial will be the first to evaluate carotid-cerebral pulse wave velocity in patients with acute ischemic stroke using transcranial Doppler. The results may provide more valuable theoretical basis for the prevention, treatment, and prognosis of acute ischemic stroke.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Análise de Onda de Pulso/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Rigidez Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Artéria Carótida Primitiva/fisiopatologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Posicionamento do Paciente/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/fisiopatologia , Decúbito Dorsal , Adulto Jovem
17.
J Stroke Cerebrovasc Dis ; 28(9): e132-e134, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239223

RESUMO

Intravascular lymphomatosis (IVL) is a rare subtype of large B-cell lymphoma that follows an aggressive course with rapidly progressive neurological involvement and potentially fatal outcome.1 We report on a 64-year-old man with progressive myelopathy at T6-T7 and recurrent cerebral infarctions. This case is illustrative of the clinical course that is seen in IVL. It aims to present a timeline of imaging findings that demonstrate the progression of disease and characteristic pathology findings. We emphasize the importance of IVL on the differential diagnosis of spinal cord infarction.


Assuntos
Isquemia Encefálica/etiologia , Infarto/etiologia , Linfoma de Células B/complicações , Medula Espinal/irrigação sanguínea , Acidente Vascular Cerebral/etiologia , Neoplasias Vasculares/complicações , Biópsia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/patologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Evolução Fatal , Humanos , Infarto/diagnóstico por imagem , Infarto/patologia , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia
18.
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
19.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(3. Vyp. 2): 5-10, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31184619

RESUMO

To analyze the main changes in the prevalence of stroke types and pathogenetic variants of ischemic stroke based on the data obtained from seven regions of the Russian Federation among the population aged 25 years and older. MATERIAL AND METHODS: In total, 29 779 cases of stroke, of which 4167 cases were registered in 2009 and 3402 cases in 2016, were detected during the period from 2009 to 2016. RESULTS AND CONCLUSION: The comparative analysis showed that the proportion of unspecified stroke (unspecified as a hemorrhage and or heart attack) decreased by 11 times from 4.7% to 0.4% (p<0.001). A decrease in 28-day mortality in ischemic stroke, intracerebral and subarachnoid hemorrhage was registered. A change in the ratio of the prevalence of pathogenetic variants of ischemic stroke was revealed. Over the 8-year period, the prevalence of cardioembolic stroke decreased from 35% to 21% (p=0.037). The prevalence of other pathogenetic variants of ischemic stroke has undergone changes. The changes in the ratio of the types of stroke studied are primarily related to the improvement of the diagnosis of stroke types, due to an increase in the percentage of computer tomography/magnetic resonance imaging performed, as well as the introduction of high-tech methods of helping patients with stroke and its effective prevention.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Adulto , Isquemia Encefálica/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Federação Russa , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(3. Vyp. 2): 24-36, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31184622

RESUMO

A comprehensive assessment of brain perfusion data in connection with the Hemorrhagic Transformation Index (HTI) score to predict hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients. MATERIAL AND METHODS: Based on propensity score matching, the authors selected retrospectively 21 case-control pairs from 71 consecutive patients with AIS in the middle cerebral artery territory. Brain computed tomography (CT) perfusion data with blood-brain barrier permeability assessment were obtained in all patients within 12 h after the onset. The infarct core (IC) and penumbra were evaluated with mean transit time (MTT), cerebral blood volume (CBV), cerebral blood flow (CBF), and permeability surface-area product (PS). The outcome was any HT on a follow-up brain CT scan within 2 weeks after the onset. RESULTS: The Firth logistic regression analysis showed that PS was an independent HT predictor in the IC (odds ratio, 8; 95% confidence interval (CI), 1.32-48.4; p=0.023). The cut-off value was 2.88 mL/100 g/min (95% normal-based CI (NB-CI): 2.41-3,34) with sensitivity 0,95 (95% NB-CI: 0.87-1.0), specificity 1 (95% NB-CI: 0.95-1.0), and area under ROC-curve 0.98 (95% NB-CI: 0.94-1.0). However, no independent HT predictor was found in the penumbra. The generalized linear model analysis revealed that the HTI score was a predictor of CBV, CBF, and PS in the IC and penumbra. As the HT risk grew simultaneously with the HTI score increment, the CBV and CBF became low with a substantial PS rise in the IC; the IC size tended to increase as well. In the penumbra, there was a progressive CBF reduction with a significant CBV and PS climb. At the same time, the MTT-CBV mismatch shrank. CONCLUSION: The IC is more likely to be the site of HT. The PS is an independent HT predictor in the IC. The HTI score can predict the HT probability as well as the brain perfusion data. As the HT risk increases, the perfusion disorders become worse in the IC and penumbra.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Encéfalo/irrigação sanguínea , Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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