Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Case Reports
Susceptibility weighted imaging features of nonketotic hyperglycemia: unusual cause of hemichorea-hemiballismus.
Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. ⋯ T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.
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Case Reports
Intracranial internal carotid artery angioplasthy and stenting in giant cell arteritis.
We report the case of a 59-year-old woman who presented with several episodes of transient ischemic attack (TIA) caused by pathologically confirmed giant cell arteritis. She continued suffering from TIAs during admission despite immunosuppressant and antithrombotic therapy. Sudden neurological deterioration with paraparesis and cognitive impairment developed. ⋯ MR angiography demonstrated severe stenosis of both intracranial internal carotid arteries (ICAs). Angioplasty and stenting on the left ICA were performed, with evident clinical improvement occurring within 24 hours. Endovascular therapy may be an alternative option to treat severe GCA with symptomatic intracranial large vessel disease not responsive to intensive conventional medical treatment.
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Diffusion tensor imaging (DTI) is useful for multiple clinical applications, but its routine implementation for children may be difficult due to long scan times. This study evaluates the impact of decreasing the number of DTI acquisitions (NEX) on interpretability of pediatric brain DTI. ⋯ Reducing NEX to shorten imaging time may impact clinical utility in a manner that does not directly correspond with SNR changes.
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Clinical Trial
Monitoring of cortical activity postreperfusion. A powerful tool for predicting clinical response immediately after recanalization.
In acute ischemic stroke, although early recanalization predicts rapid neurological recovery, in some cases early reperfusion does not immediately correlate to clinical improvement as "stunned brain" patients. The cortical activity monitoring in stroke patients is usually performed to evaluate epileptic activity through electroencephalogram. Bispectral index (BIS) monitor the cortical activity by fronto-temporal electrodes and is currently used for monitoring level of conscious on sedo-analgesia patients. Some studies have shown certain sensibility to detect cerebrovascular events during carotid revascularization. We aimed to evaluate the impact of BIS monitoring before and shortly after reperfusion on early and delayed clinical improvement on stroke patients. ⋯ BIS value is associated with clinical and radiological variables in acute stroke patients. The final BIS value is a powerful independent predictor of further clinical improvement. Larger studies are needed to assess the value of post reperfusion cortical activity measured by BIS.
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Comparative Study Clinical Trial
Diffusion-weighted imaging volume as the best predictor of the diffusion-perfusion mismatch in acute stroke patients within 8 hours of onset.
Diagnostic accuracies of standard NCCT, CTA, CTA-SI, FLAIR, and DWI to detect the diffusion-perfusion mismatch (DPM) were compared. ⋯ DWI volume was the best predictor of DPM.