Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Identification of significant asymptomatic carotid artery stenosis (ACAS) is important because of the stroke-risk reduction observed with carotid endarterectomy. The authors developed and validated a simple scoring system based on routinely available information to identify persons at high risk for ACAS using data collected during a community health screening program at various sites in western New York. A total of 1331 unselected volunteers without previous stroke, transient ischemic attack, or carotid artery surgery were evaluated by personal interview and duplex ultrasound. ⋯ The scheme effectively stratified the validation set (n = 444); the likelihood ratio and posttest probability for ACAS in the high-risk group were 3.0 and 35%, respectively, and in the intermediate and low-risk groups were 1.4 and 20% and 0.4 and 7%, respectively. Routinely available information can be used to identify persons in the community at high risk for ACAS. Doppler ultrasound screening in this subgroup may prove to be cost-effective and have an effect on stroke-free survival.
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Case Reports
Transcranial color-coded sonography of a vein of Galen arteriovenous malformation in an adult.
The case of an adult harboring a vein of Galen arteriovenous malformation (VGAM) is reported. Diagnosis was established by computed tomography (CT) and digital subtraction angiography and confirmed afterwards by transcranial color-coded sonography (TCCS). ⋯ The results of TCCS were validated by angiography, with which they showed good correlation. Thus, it can be concluded that TCCS may be a useful adjunct to CT and angiography to noninvasively monitor adults with VGAM.
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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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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.