Journal of neuroimaging : official journal of the American Society of Neuroimaging
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The case of a young woman with basilar artery dissection, possibly precipitated by trauma, is presented, and the literature is reviewed.
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Invasive recording of intracranial pressure (ICP) changes during cerebrospinal fluid (CSF) infusion-drainage tests have been used to estimate elastance and reserve capacity of craniovertebral contents. The increase in ICP and its pulse-related oscillations lead to "cuff constriction" of cerebral veins. The purpose of this study is noninvasive assessment of elastance and reserve capacity of craniovertebral contents (RCCC) by measurement of flow velocity (FV) in the straight sinus by transcranial Doppler (TCD) during body tilt tests, which cause changes in ICP. ⋯ Elastance in patients was usually significantly higher than in healthy volunteers. Evaluation of cerebral venous circulation during body tilt tests clearly differs between the patients with IH and the healthy volunteers. The degree of this difference depends on the localization and character of the pathologic process.
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The neuropathologic sequelae of carbon monoxide (CO) toxicity have been well described in postmortem examinations. Globus pallidus damage as well as diffuse white matter lesions and encephalopathic changes occur. Brain CT has provided imaging correlates to the premortem changes. ⋯ Cerebral edema changes may occur early with subsequent demonstration of globus pallidus lesions and white matter changes. Globus pallidus lesions in many cases do not correlate directly to clinical status and outcome; however, the presence of diffuse white matter disease is a more reliable index of both. These changes are seen in patients in both accidental exposures to CO and in suicide attempts.
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Comparative Study
Multimodality monitoring during passive tilt and Valsalva maneuver under hypercapnia.
In occlusive cerebrovascular disease cerebral blood flow (CBF) autoregulation can be impaired and constant CBF during fluctuations in blood pressure (BP) cannot be guaranteed. Therefore, an assessment of cerebral autoregulation should consider not only responsiveness to CO2 or Diamox. Passive tilting (PT) and Valsalva maneuver (VM) are established tests for cardiovascular autoregulatory function by provoking BP changes. ⋯ Combined BP and MCA-DF assessment under hypercapnia enables investigating the effect of rapid changes of blood pressure on CO2-induced predilated cerebral arterioles. Assuming no interference of hypercapnia-induced vasodilation, VM, with its rapid, distinct changes in BP, seems especially to be adequate provocation for CBF autoregulation. This combined vasomotor reactivity might provide a more sensitive diagnostic tool to detect impaired cerebral autoregulation very early.
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Infective endocarditis (IE) is an elusive systemic disorder that is often associated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such findings has been only sparsely described previously. The authors report cranial MRI findings in 12 patients with IE. ⋯ Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in the evaluation of patients with IE. The presence of characteristic cranial MRI lesions, especially of multiple types, may prompt early diagnosis and treatment.