摘要:

Single‐photon emission computed tomography (SPECT) and transcranial Doppler (TCD) ultrasound are of good prognostic value in acute stroke, and combined they may be an accurate way to determine a target group of patients with maximum therapeutic response. Seventy consecutive patients were studied (42 with middle cerebral artery strokes, 18 with transient ischemic attacks [TIAs]; 10 were excluded due to failure of insonation). Two SPECT studies were performed at 2.1 ± 1.2 and 13.8 ± 3.1 days after onset. Serial TCD studies were done at 10 hours and at the time of the SPECT studies. Neurological deficit was scored on admission and 2 weeks later (using the Canadian Neurological Scale). Cerebral perfusion index (CPI) was derived by multiplying the values for TCD and SPECT patterns. Positive correlation was obtained in all 16 patients in whom cerebral angiography was performed within the first 3 days after onset. The occlusive TCD pattern and absence of perfusion on SPECT were common in the stroke group (19/42 patients) and were never seen in those with TIAs. A normal TCD pattern and normal perfusion on SPECT were more common in the patients with TIAs (9/18 vs 8/42, p = 0.02; 5/10 vs 1/40, p = 0.0003). The occlusive TCD and SPECT patterns were associated with the highest mean infarction volume (147 ± 87 vs 19 ± 21, p<0.0001) and all nonocclusive TCD and SPECT patterns were associated with the better short‐term outcome (43.2 ± 33.9 vs 92.4 ± 20.2, p<0.0001). A tendency for hyperfixation of the tracer to be more common in cardioembolic stroke was found. The three grades of the initial CPI (1–5, 6–12, 15–20) were found to predict different degrees of short‐term outcome (good, medium, and poor). The TCD and SPECT combination (CPI) may prove to be a safe, fast, and reliable noninvasive substitute for angiography.

ISSN:1051-2284    

DOI:10.1111/jon199334209

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Paracoccidioidomycosis is a systemic mycosis, endemic in South and Central America, that affects the central nervous system (CNS) in almost 10% of patients. Neurological involvement includes two different clinical forms: meningeal and granulomatous, also known as the pseudotumor form. Five patients with biopsy‐proved systemic paracoccidioidomycosis and neurological complaints were studied by magnetic resonance imaging. CNS involvement was detected in all patients in the form of multiple round or lobulated lesions, predominantly hypointense on T2‐weighted images and ring or nodular enhancement on post‐gadolinium T1‐weighted images. The lesions were distributed diffusely, with a slight predominance in the supratentorial compartment, although infratentorial lesions were also observed, mainly in the cerebellum. Hypointense lesions on T2‐weighted images persisted in all 3 patients reexamined after treatment, whereas enhancing lesions on post‐gadolinium T1‐weighted images turned isointense in 2 patients. Magnetic resonance imaging is a sensitive method in documenting CNS paracoccidioidomycosis, most frequently as supratentorial and infratentorial multiple, round or lobulated hypointense lesions on T2‐weighted images.

ISSN:1051-2284    

DOI:10.1111/jon199334216

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Cerebral ischemic lesions sometimes are clinically characterized by major cognitive impairment such as vascular dementia. Among the quantifiable factors able to cause focal and/or diffuse ischemic lesions, carotid atherothrombotic plaques represent possible "foci" of embolism that lead to cortical and/or subcortical infarcts. The aim of the present study was to investigate the qualitative and quantitative aspects of carotid plaques in a group of patients affected by vascular dementia and a group of patients affected by multiple brain infarctions, in order to verify whether significant differences can be detected. These data point out the importance of plaque composition and morphology in the pathogenesis of brain infarction leading to dementia.

ISSN:1051-2284    

DOI:10.1111/jon199334220

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Ten patients with Parkinson's disease were studied by phosphorus 31 magnetic resonance spectroscopy. The brain phosphocreatine‐inorganic phosphate ratio was abnormal owing to an increased inorganic phosphate content, and the phosphorylation potential was consequently reduced. Phosphocreatine and ADP levels and pH were normal. These findings indicate abnormal brain energy metabolism in Parkinson's disease.

ISSN:1051-2284    

DOI:10.1111/jon199334225

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Assessment of the vertebral arteries is often difficult with conventional duplex ultrasonography. This study of 60 patients aimed to determine the potential advantages of color Doppler imaging over conventional duplex ultrasonography in the evaluation of vertebral arteries, specifically three extracranial segments of these vessels. Both methods allowed visualization of the vertebral artery in the midcervical course (V2 and distal V1 segments) in all subjects. Color Doppler imaging appeared more effective for visualization of the VO and the proximal V1 segments (on the right side in 88% of patients and on the left side in 73%). Conventional duplex ultrasonography imaged the ostium on the right side in 80% of patients and on the left side in 65%, but was difficult and time‐consuming. Visualization at the atlas loop (V3 segment) was rarely successful with duplex sonography, whereas color Doppler imaging visualized the vertebral artery on the right side in 87% of patients and on the left side in 85%. Color Doppler imaging allows better visualization of the proximal and distal segments of the vertebral arteries, compared to conventional duplex ultrasonography.

ISSN:1051-2284    

DOI:10.1111/jon199334229

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Positron emission tomography (PET) with fluorine‐18‐2‐fluorodeoxyglucose (FDG) showed bifrontal and bitemporal hypometabolism in amyotrophic lateral sclerosis (ALS)‐dementia complex (n = 6; 5 by PET, 4 by postmortem examination) as compared to nondemented ALS (n = 10) and normal subjects (n = 10). Subjects were of comparable age, ALS patients were of comparable motor severity, and those with dementia were either mildly or moderately impaired at the time of PET study. ALS in all patients was of sporadic nature. Results, using Kruskai‐Wallis comparisons, revealed that normalized mean FDG values for the superior frontal and superior and mesial temporal cortical regions in ALS‐dementia patients were diffusely, symmetrically, and significantly lower (p<0.005) than values from either the normal or the nondemented ALS group. FOG values for the caudate, putamen, lateral temporal cortex, occipital cortex, and cerebellum did not distinguish the groups. Pathological data in 4 ALS‐dementia complex patients revealed significant gross atrophy of gyri in both frontal lobes. The atrophy was less pronounced in the temporal lobes. The striking microscopic finding was an extensive proliferation of reactive astrocytes in the subcortical white matter. ALS‐dementia brains were free of Lewy bodies, Pick bodies, ischemic infarctions, and Alzheimer pathological changes. Neurobehavioral and neuropsychological data in ALS‐dementia patients revealed decrements in psychometricintelligence, memory, orientation aha attention, verbal fluency, concept formation and abstraction, mental speed and flexibility, and expressive language and writing skills, and relatively preserved stereognosis and visuospatial orientation.

ISSN:1051-2284    

DOI:10.1111/jon199334234

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

The use of transcranial Doppler sonography (TCD) for the evaluation of patients with ischemic cerebrovascular disease remains controversial. This study was organized to gather preliminary data regarding the sensitivity and specificity of TCD when compared to cerebral angiography in detecting stenosing lesions and collateral flow patterns of the anterior cerebral circulation. Forty‐two patients from six medical centers were prospectively enrolled. Each received cerebral angiography and TCD testing within 24 hours of each other. Based on TCD criteria established a priori, the results were first analyzed by a blinded investigator and then by computer. Computerized analyses were then repeated with modified criteria. Collateral flow through the anterior communicating and ophthalmic arteries was detected with sensitivities of 62% and 100%, and specificities of 98% and 92%, respectively. Internal carotid artery proximal and distal severe (>70%) stenoses were detected with sensitivities of 79% and 1 00% and specificities of 88% and 97%. Middle and anterior cerebral artery stenoses and middle cerebral artery occlusion were detected with specificities exceeding 98%; however, the data were insufficient to determine sensitivity. Computerized analyses did not permit improvement of sensitivity and specificity of the baseline criteria. The selected TCD criteria are highly specific in detecting intracranial stenoses and collateral flow patterns of the anterior circulation. The criteria have limited but acceptable sensitivity and specifity in detecting internal carotid artery origin severe stenoses, and are highly sensitive in detecting ophthalmic artery retrograde flow. A study with a larger sample is necessary to provide definitive guidelines for diagnosis.

ISSN:1051-2284    

DOI:10.1111/jon199334242

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Conventional magnetic resonance imaging (MRI) and spine magnetic resonance angiography (MRA) demonstrated a glomus‐type intradural arteriovenous malformation of the upper cervical region of the spine in a 24‐year‐old woman. Gadolinium‐enhanced, three‐dimensional, phase‐contrast angiography displayed the nidus and feeders of the arteriovenous malformation. The clinical features of the two most common types of spinal arteriovenous malformations (dural arteriovenous fistula and glomus intradural arteriovenous malformation) are reviewed. Conventional MRI and spine MRA may obviate the need for performing total spinal myelography in patients suspected of having spinal arteriovenous malformations.

ISSN:1051-2284    

DOI:10.1111/jon199334250

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Intracranial arterial vasospasm is an important consequence of subarachnoid hemorrhage. In posttraumatic patients, this phenomenon is becoming increasingly recognized with noninvasive techniques that evaluate (1) vascular stenosis, such as transcranial Doppler (TCD) ultrasound, and (2) regional cerebral blood flow, such as single‐photon emission computed tomography (SPECT). A posttraumatic patient developed symptomatic vasospasm that was detected by TCD and SPECT and then treated with percutaneous transluminal balloon cerebral angioplasty, which improved the symptoms. The anatomical and functional results of angioplasty were evaluated also by TCD and SPECT, which showed a reduction in the severity of stenosis and improved blood flow, respectively.

ISSN:1051-2284    

DOI:10.1111/jon199334252

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

An acute pancerebellar syndrome developed in a 40‐year‐old, alcoholic, malnourished woman while she was recovering from alcoholic hepatitis in the hospital. Brain magnetic resonance imaging showed a lesion in the pons and helped identify this syndrome as central pontine myelinosis despite the lack of typical neurological signs and fluxes of serum sodium levels.

ISSN:1051-2284    

DOI:10.1111/jon199334255

出版商:Wiley    

年代:2016

数据来源: WILEY