Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Parenchymal hypodensity is a proposed risk factor for hemorrhage after recombinant tissue plasminogen activator (TPA) thrombolysis for ischemic stroke. In Buffalo, NY, and Houston, TX, the authors reviewed 70 patients who were treated with intravenous TPA for acute middle cerebral artery (MCA) stroke. Two observers blinded to clinical outcome analyzed initial noncontrast head computed tomography (CT) scans. ⋯ Logistic regression indicated that basal ganglia hypodensity was the best single predictor of hemorrhage. Hypodensity and NIHSS score together predicted all cases of hemorrhage. The authors conclude that basal ganglia hypodensity quantified by CT may be a useful method of risk stratification to select acute MCA stroke patients for thrombolytic therapy.
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Regression of symptomatic intracranial atherostenosis is not known to be a common occurrence. In this case, delay of basilar reconstruction by endovascular means permitted serial angiographic assessment of plaque change. The use of high-dose atorvastatin over a 2-week period was associated with marked angiographic improvement. Medical programs of plaque stabilization may provide adjunctive benefit in patients with symptomatic intracranial disease.
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To test the hypothesis that syndrome X is a systemic vascular disorder, the authors studied 40 patients with this diagnosis using technetium-99m hexamethylpropylene amine oxime and single photon emission computed tomography (SPECT) brain images. Twenty-three of 25 cases with definite myocardial perfusion defects diagnosed by thallium-201 myocardial perfusion SPECT also had multiple hypoperfusion areas in the brain versus 2 of 15 patients without thallium myocardial defects. The parietal lobes were the most common hypoperfusion areas, and cerebellum was the least common. Syndrome X is a systemic vascular disorder with a high incidence of hypoperfusion lesions of the brain and is usually coincident with myocardial defects.
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Broca's area, which includes the pars triangularis (PTR), is a neuroanatomical region important in speech and language production. Linear measures of the PTR have been found to be asymmetric, with the direction of the asymmetry correlating with language dominance determined by Wada testing. It is unclear, however, whether these linear measurements correlate with volumetric measures, and it is also unknown whether white matter and/or gray matter contribute differentially to these asymmetries. ⋯ Linear measures of the left and right hemispheres were highly correlated with volumetric measures. Underlying gray and white matter both contributed to PTR asymmetry. Anatomical boundaries and four configurations (V, U, Y, and J) are discussed with reference to potential interhemispheric differences.
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A Nigerian man had acute onset of headache and vertigo due to a cerebellar mass. A brain biopsy of the mass revealed toxoplasmosis despite repeated negative HIV-1 serology. ⋯ The lesion showed a biochemical and perfusion pattern that was intermediate for infectious and neoplastic processes. Further neuropathology confirmed a secondary diagnosis of lymphomatoid granulomatosis.