Journal of neuroimaging : official journal of the American Society of Neuroimaging
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The authors describe serial positron emission tomography (PET) and magnetic resonance imaging (MRI) studies in a patient with pathologically confirmed Rasmussen Encephalitis (RE). Results of initial PET and MRI studies were normal. Subsequent studies showed involvement of the percentral and postcentral gyri and the putamen on PET, and the precentral and postcentral gyri on MRI. ⋯ The authors demonstrate the evolution of changes on PET and MR images in a patient with RE. Despite early pathologic confirmation of RE, there were no definite structural or functional imaging changes on PET or MRI until 3 years after symptom onset. These findings demonstrate the variability of imaging changes in RE, and the need to carefully correlate electro-physiologic and clinical findings to confirm the diagnosis of RE.
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The authors determine whether magnetic resonance imaging (MRI) during acute hospitalization for spontaneous intracerebral hemorrhage (ICH) provides new diagnostic information. ICD-9 codes were used to identify consecutive patients with spontaneous ICH at Hermann Hospital, Houston, Texas, between January 1995 and August, 1997. Two investigators employed rigorous criteria to determine whether the MRI findings led to a specific new diagnosis. ⋯ The yield of MRI was low in basal ganglia and thalamic hemorrhage. Two of 23 (9%) patients with deep ICH and 13 of 44 (30%) patients with lobar and infratentorial hemorrhage had etiology determined by MRI. Timing of MRI did not affect yield.
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Intravascular lymphomatosis (IL) is a rare variant of non-Hodgkin's lymphoma with an unusual predilection for the central nervous system (CNS). Most cases are not diagnosed until postmortem because of variable clinical presentation and nonspecific laboratory findings. ⋯ The authors describe brain MRI findings of linear, punctate, and patchy enhancement suggestive of CNS IL in two patients confirmed by brain biopsy/histologic studies. High index of clinical suspicion and careful interpretation of MRI (including gadolinium contrast studies) may contribute to premortem diagnosis and early intervention of this often-missed disease.
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Comparative Study
A new pocket-sized transcranial ultrasound device (NeuroDop): comparison with standard TCD.
The NeuroDop is a new bedside assessment tool consisting of a continuous wave ultrasound probe attached to a stethoscope earpiece. This study was designed to compare middle cerebral artery (MCA) velocity assessment obtained with the NeuroDop versus standard transcranial Doppler (TCD). TCD technologists performed continuous wave NeuroDop studies followed by standard TCD studies on 60 subjects. ⋯ This novel stethoscope-continuous wave unit has excellent sensitivity in detecting presence of MCA patency. Moreover, MCA velocities can be characterized to a reasonable degree of accuracy based on NeuroDop auditory characteristics. The NeuroDop shows promise as a tool to rapidly assess and serially monitor presence and amplitude of MCA velocity and may help guide thrombolytic and other emergency management decisions in stroke patients.
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Case Reports
Diffusion-weighted MRI diagnosis of pure motor stroke limited to primarily distal leg weakness.
Pure motor stroke (PMS) manifesting as distal weakness of a single extremity has rarely been described. The authors report a 59-year-old man with PMS who had primarily distal weakness of a single lower extremity, which to the authors' knowledge has not been previously described. Four days after onset, positive diffusion-weighted imaging confirmed that the small subcortical T2-weighted hyper-enhancing and nonenhancing T1-weighted hypo-intensity noted on magnetic resonance imaging (MRI) represented an acute PMS that was the cause of the patient's weakness. Increased awareness of this rare clinical presentation of PMS coupled with the promise of imaging the PMS with diffusion-weighted MRI should lead to earlier stroke intervention in these patients.