AJNR. American journal of neuroradiology
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The prognosis of comatose survivors is determined by clinical examination. Early laboratory indicators of poor prognosis (such as evoked potentials) have low sensitivity. The role of MR imaging as a confirmatory study was investigated. ⋯ MR imaging in comatose survivors may parallel the pathologic findings in severe anoxic-ischemic injury, and extensive abnormalities may indicate little to no prospects for recovery. If confirmed, MR imaging may have a role as a prognosticating test in anoxic-ischemic coma.
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Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We hypothesized that determining characteristic imaging features of pyogenic ventriculitis in patients with appropriate risk factors might improve recognition of this severe infection. ⋯ Ventricular debris was the most frequent sign of ventriculitis in this series. An irregular level was characteristic of debris in ventriculitis. Hydrocephalus and ependymal enhancement were less frequent signs. Detection of ventricular debris might facilitate diagnosis of pyogenic ventriculitis, a potentially fatal infection, and thus permit appropriate therapy.
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AJNR Am J Neuroradiol · Aug 2001
Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain.
There has been concern regarding the safety of revascularization procedures of vessels supplying the brain vessels because of the risk of cerebral embolization during the procedure. We have observed a high incidence of hyperintense lesions on diffusion-weighted MR images of the brain after stenting at the carotid bifurcation. The hypothesis of this study is that diffusion-weighted MR imaging of the brain can reveal new diffusion abnormalities after angioplasty or angioplasty plus stenting of arteries supplying the brain, other than at the carotid bifurcation. Therefore, we prospectively obtained diffusion-weighted MR images of the brain before and after such revascularization procedures. ⋯ Revascularization procedures of arteries supplying the brain were associated with new lesions on the diffusion-weighted MR images of the brain after 22% of the procedures, provided that MR imaging could be performed, indicating the occurrence of cerebral microemboli during such procedures. Diffusion-weighted MR imaging of the brain can be used as a tool to assess the impact of modifications of procedural technique and/or the use of cerebral protection devices on the occurrence of such lesions.
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AJNR Am J Neuroradiol · Aug 2001
Endovascular management of vein of Galen aneurysmal malformations presenting in the neonatal period.
Neonates with vein of Galen aneurysmal malformations (VGAMs) presenting with cardiac failure have high morbidity and mortality, and outcomes are significantly better in those presenting in later childhood. Neurologic outcomes in survivors are perceived to be uniformly poor, which may lead to the neonate being denied treatment. We assessed outcomes of modern neonatal intensive care and endovascular embolization in a consecutive series of such neonates presenting with cardiac failure. ⋯ Endovascular therapy with modern neuroanesthetic and neurointensive care can provide good outcomes even in the highest-risk neonates with VGAMs and cardiac failure. If medical management of cardiac failure fails, and there is no evidence of gross cerebral parenchymal damage on imaging, urgent endovascular treatment is feasible and can reduce the almost-100% mortality otherwise expected, without invariably severe morbidity. Use of multiple embolization strategies in multiple stages usually is necessary in these patients, and novel approaches and embolic agents may be necessary.
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AJNR Am J Neuroradiol · Aug 2001
Comparative StudyPerfusion-sensitive MR imaging of gliomas: comparison between gradient-echo and spin-echo echo-planar imaging techniques.
The different sensitivities to vessel size of gradient-echo echo-planar imaging (GE-EPI) and spin-echo EPI (SE-EPI) might indicate the relative cerebral blood volumes (rCBVs) of different tumor sizes. The techniques of GE-EPI and SE-EPI were compared for detecting low- versus high-grade gliomas. ⋯ The GE-EPI technique seems more useful for detecting low- versus high-grade gliomas than the SE-EPI technique.