Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI.
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Acute Disease↗
Biomedical subjects
O Jansen
Publications and source records attributed to O Jansen.
Bilateral basal ganglion haemorrhage in diabetic ketoacidotic coma: case report.
We report bilateral oedema and haemorrhagic transformation in the basal ganglia of a 59-year old woman with severe diabetic ketoacidosis. Lack of cerebral vascular autoregulation, followed by blood-brain barrier disruption due to the so-called breakthrough mechanism is presumed to be the cause.
Basal Ganglia↗
Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils.
We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels--three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses--by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded.
Adult↗
Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke.
PURPOSE: The feasibility and safety of combining carotid surgery and thrombolysis for occlusions of the internal carotid artery (ICA) and the middle cerebral artery (MCA), either as a simultaneous or as a staged procedure in acute ischemic strokes, was studied. METHODS: A nonrandomized clinical pilot study, which included patients who had severe hemispheric carotid-related ischemic strokes and acute occlusions of the MCA, was performed between January 1994 and January 1998. Exclusion criteria were cerebral coma and major infarction established by means of cerebral computed tomography scan. Clinical outcome was assessed with the modified Rankin scale. RESULTS: Carotid reconstruction and thrombolysis was performed in 14 of 845 patients (1.7%). The ICA was occluded in 11 patients; occlusions of the MCA (mainstem/major branches/distal branch) or the anterior cerebral artery (ACA) were found in 14 patients. In three of the 14 patients, thrombolysis was performed first, followed by carotid enarterectomy (CEA) after clinical improvement (6 to 21 days). In 11 of 14 patients, 0.15 to 1 mIU urokinase was administered intraoperatively, ie, emergency CEA for acute ischemic stroke (n = 5) or surgical reexploration after elective CEA complicated by perioperative intracerebral embolism (n = 6). Thirteen of 14 intracranial embolic occlusions and 10 of 11 ICA occlusions were recanalized successfully (confirmed with angiography or transcranial Doppler studies). Four patients recovered completely (Rankin 0), six patients sustained a minor stroke (Rankin 2/3), two patients had a major stroke (Rankin 4/5), and two patients died. In one patient, hemorrhagic transformation of an ischemic infarction was detectable postoperatively. CONCLUSION: Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies.
Acute Disease↗
[MRI with fat suppression in the visualization of wall hematoma in spontaneous dissection of the internal carotid artery].
PURPOSE: Comparison of different MR-examination techniques for the diagnosis of acute spontaneous internal carotid artery dissection. PATIENTS AND METHODS: 13 patients (age range 23-59 years) with symptomatic spontaneous dissection of the internal carotid artery were examined. The MRI protocol contained a transverse spin echo sequence, a time-of-flight MR-angiography and a coronal fat suppressed T1-weighted sequence. The earliest examination was performed three days after symptom onset. Follow-up extended up to 30 months. We compared the three different sequences to find out the one that demonstrated the hematoma best. RESULTS: MR-angiography shows a narrowing of the vessel diameter in early examinations. During the subacute stage methemoglobin can obscure this finding. From the third day on fat suppressed T1-weighted images showed a hyperintense hematoma that strongly contrasted to the surrounding fatty tissue. Fat suppressed images showed a hyperintense hematoma up to 10 months after symptom onset while MRA and spin echo sequences did not. CONCLUSIONS: Fat suppressed T1-weighted images are superior in showing vessel wall hematoma and should thus be used in the standard MR-protocol for spontaneous internal carotid artery dissection.
Adipose Tissue↗
Relative value of MR imaging as compared with CT in the diagnosis of inflammatory paranasal sinus disease.
PURPOSE: To evaluate the relative value of magnetic resonance (MR) imaging versus computed tomography (CT) in the diagnosis of inflammatory paranasal sinus disease. MATERIALS AND METHODS: In 30 patients suspected of having or known to have inflammation of the paranasal sinuses, both coronal CT and coronal T1-weighted, three-dimensional, gradient-echo MR imaging of the paranasal sinuses were performed. Visualization of anatomic details, kind and extent of inflammatory disease, and artifacts from dental work were scored. The scores were compared by using the Wilcoxon matched pairs signed rank test. Interexamination agreement between the two methods was calculated by using a kappa analysis. RESULTS: Most bone structures of the infundibular complex were significantly better visualized at CT than at MR imaging. Orbital and brain anatomy were visualized better at MR imaging than at CT. No artifacts from dental work occurred in diagnostically relevant regions at MR imaging. There was a substantial to almost perfect agreement between CT and MR imaging for every kind and extent of the disease except for mucosal thickening in the maxillary and frontal sinuses, in the nasal cavity, and in the infundibulum. CONCLUSION: CT is superior to MR imaging in the depiction of fine bony details and anatomic variants and thus is superior to MR imaging in helping plan functional endoscopic sinus surgery. However, there are patient groups in which MR imaging can be used as a primary tool in screening for sinusitis.
Adult↗
A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage.
BACKGROUND AND PURPOSE: Diagnostic imaging in hyperacute ischemic stroke has been revolutionized by the introduction of diffusion- and perfusion-weighted MRI (DWI and PWI). CT, however, is still needed to exclude intracerebral hemorrhage (ICH). The purpose of our study was to determine the diagnostic accuracy of a standardized, multimodal MRI (mMRI) stroke protocol in the qualitative and quantitative assessment of hyperacute ICH (<6 hours). METHODS: We investigated 9 patients with hyperacute ICH with CT followed immediately by a standardized mMRI stroke protocol (DWI, PWI [T2*-WI], FLAIR, T2-WI, and MRA). The time interval between MRI and symptom onset ranged from 3 hours to 5 hours 45 minutes. We analyzed and compared the size of the hematoma on CT and all mMRI images by semiautomatic volumetry. RESULTS: ICH was unambiguously identified on the basis of all mMRI sequences. With increasing susceptibility effect (T2*-WI), the ICH, appearing as an area of hyperintensity with central signal loss, became qualitatively most evident. Regarding quantitation, T2*-WI overestimated (median and mean difference, 18.9%/17.8%; SD final sigma=24.4%) and DWI correlated best (median and mean difference, 3.97%/-4.36%; SD final sigma=37. 42%) with hematoma size on CT. CONCLUSIONS: Multimodal stroke MRI is as reliable as CT in the assessment of hyperacute ICH. Therefore, additional CT is no longer necessary to rule out ICH in hyperacute stroke. The use of mMRI alone in the diagnostic workup of a hyperacute stroke patient saves time and costs while rendering all the critical information needed to initiate an optimal treatment.
Acute Disease↗
Extradural spinal hemangioblastomas: report of two cases.
Two cases of predominantly extraspinally extra- and intradural spinal cord hemangioblastomas in two patients each with and without von Hippel-Lindau-disease are reported. Preoperative MRI and angiographic findings are presented and the differential diagnosis is discussed. The surgical procedure is described and the literature of hemangioblastomas in this rare localization is reviewed. Improvements in both radiologic diagnosis and microsurgical techniques, and consequent screening programs will enhance life expectancy in patients afflicted with von Hippel-Lindau disease.
Adult↗
[The neuroradiological findings in Behçet's disease].
PURPOSE: We present the typical neuroradiological findings in three patients with neuro-Behçet in comparison with a review of neuroradiological and histopathological findings described in the literature. MATERIAL AND METHODS: In three male patients aged 32-57 years with Behçet's disease and neurological symptoms cranial CT and MRI studies were carried out. Findings were monitored over a period of 6-18 months. Additionally, cerebral and renal DSA were performed in two patients. RESULTS: In two patients we found acute inflammatory lesions located in the brainstem and the periventricular white matter, some of which were associated with an acute inflammatory disruption of the blood-brain barrier. Lesions decreased in size under treatment, but complete resolution was not consistently noted. In the third patient we found a thrombosis of the superior sagittal sinus but no other intracranial abnormalities. CONCLUSIONS: Our findings agree with those described in the literature as being typical of Behçet's disease. Inflammatory lesions most commonly occur in the brain stem, followed by the basal ganglia and the cortex and white matter of both the cerebrum and cerebellum. In contrast to venous sinus thrombosis, brainstem atrophy and cortical or cerebellar lesions, white matter lesions have little diagnostic value, irrespective of their location. The definitive diagnosis of Behçet's disease is made on the basis of clinical criteria.
Adult↗
[Neuroradiologic diagnosis in acute arterial cerebral infarct. Current status of new methods].
At least three questions has to be answered by imaging methods, when new therapies in acute ischemic stroke should be used: 1. Is there a cerebral ischemia? 2. What is the size of the irreversible damaged tissue and what is the size of the safeable tissue? Is there still a vessel occlusion? New MRI-techniques including MR-angiography, diffusion-weighted imaging and perfusion-MRI, have the potential to describe the status of the brain in detail and to answer these questions. However, the value of these techniques for therapeutical decisions (thrombolysis) is unclear and has to be evaluated in clinical studies. Therefore in clinical routine these decisions should still be based on informations from CT and perhaps CT-angiography.
Brain↗
[Effect of brain edema on the recurrence pattern of malignant gliomas].
PURPOSE: To assess the influence of initial preoperative brain edema in malignant gliomas on regrowth patterns. SUBJECTS AND METHODS: 79 patients with histologically verified supratentorial malignant glioma were prospectively studied by magnetic resonance imaging (MRI) before and every 2-3 months after surgery. The median follow-up time was 11 months. We correlated the configuration of the initial vasogenic edema on T2-weighted images with tumor regrowth patterns on contrast-enhanced T1-weighted images. RESULTS: 35/47 tumor regrowths (75%) imitated the initial edema configuration, while 11/47 occurred within the initial tumor bed; in one case tumor recurrence was multilocal. CONCLUSION: In glioblastoma, tumor regrowth patterns correlate positively with the configuration of the initial vasogenic brain edema. The initial, "presurgical" peritumoral edema should thus be considered when planning further treatment.
Adult↗
[Periorbital pressure and papilledema.Papilledema, episcleral glaucoma and tinnitus in multiple dura fistulas and sinus thrombosis].
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Arteriovenous Fistula↗
[Computerized tomography and magnetic resonance imaging findings in central neurocytoma].
PURPOSE: Analysis of our CT and MRI findings in patients with central neurocytomas in comparison with the relevant literature. MATERIALS AND METHODS: 5 patients were examined by CT and MRI. A retrospective analysis of the histologically confirmed tumors of our patient group and date from the literature was performed under the following criteria: 1. topography, 2. extent, 3. contrast medium behavior, 4. calcifications, 5. presence of intramural cysts, and 6. vascularization. These properties were evaluated according to a 5 point scale. RESULTS: All tumors originated in the roof of a lateral ventricles with participation of the pellucid septum and extended intraventricularly (5/5), showed cystic components (5/5), and took up contrast medium (5/5). Contrast medium uptake was visible in both CT and MRI. In contrast, only three of the 5 tumors revealed calcifications (3/5) and these were better visible in CT than in MRI, no pathological vessels were detected. Because of its multi-planar representations and better soft-tissue contrast, MRI was superior to CT for the exact determination of origin and position of the tumors. The small cystic, inhomogenous appearance in T2-weighted images was considered to be an especially typical feature. CONCLUSIONS: The typical appearance of central neurocytomas in CT and MRI provides information for the differential diagnosis from other intraventricular tumors. The definitive diagnosis is provided by neuropathological evaluation.
Adolescent↗
[Magnetization transfer contrast: experimental sequence optimization for study of the cerebral substantia alba].
PURPOSE: A new application for magnetization transfer (MT) MR imaging is the investigation of cerebral white matter. For that a pure MT effect is desirable. Our purpose was the optimization and testing of an MT sequence for investigations of cerebral white matter. MATERIAL AND METHODS: Experimental investigations were performed in phantom material and in 5 wistar rats using various frequency offsets (FO) (200 Hz-30,000 Hz). Relative signal suppression (rSS) for the phantom material and for callosal white matter of the rat was calculated. The optimized sequence was tested in 25 healthy volunteers. RESULTS: A relatively pure MT effect was achieved with FO > 4000 Hz. rSS for cerebral white matter structures was generally higher than rSS für cerebral gray matter structures. rSS for cerebral white matter structures ranged from 45-50%. CONCLUSION: We present a fast MT sequence with high rSS for cerebral white matter and a relatively pure MT effect. Owing to the high rSS-values we expect that this sequence improves differentiation of cerebral white matter lesions. Because of the confusing variety of MT sequence currently described in the literature we believe that standard parameters should be defined to make published results comparable.
Animals↗
[Radiological findings in intracerebral tuberculoma].
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Adult↗
Local fibrinolysis and aspiration of intracerebral hematomas in rats. An experimental study using MR monitoring.
Serial magnetic resonance (MR) imaging has not yet been validated in the therapy of experimental intracerebral hematomas in a rat model. It is possible to test the effect of local fibrinolysis and aspiration on the clot volume using serial magnetic resonance imaging and different MR-sequences. Experiments were carried out in 22 male Sprague-Dawley rats. Intracerebral hematoma was produced by injection of fresh autologous blood into the caudate nucleus using a double injection technique. Thirty minutes later 10 rats were treated by injecting 12 microliters of recombinant tissue plasminogen activator. MR-imaging was performed immediately after generation of the hematoma and after clot lysis. The clot volume measured in the magnetic resonance images was compared with that obtained in stained histological serial sections at the end of the experiment. Serial MR scanning demonstrated a significant reduction (p < 0.01) of hematoma volume after fibrinolysis followed by aspiration of the blood clot. The best correlation between MR- and histological volumetry was found on RF-spoiled FLASH 2D-images. This study documents the efficacy of MRI in detecting and delineating the size of acute intracerebral hematomas and its time course. Local fibrinolysis and aspiration can be simulated in an experimental rat model.
Animals↗
Early hemicraniectomy in patients with complete middle cerebral artery infarction.
BACKGROUND AND PURPOSE: Malignant, space-occupying supratentorial ischemic stroke is characterized by a mortality rate of up to 80%. Several reports indicate a beneficial effect of hemicraniectomy in this situation. However, whether and when decompressive surgery is indicated in these patients is still a matter of debate. METHODS: In an open, prospective trial we performed hemicraniectomy in 63 patients with acute complete middle cerebral artery infarction. Initial clinical presentation was assessed by the Scandinavian Stroke Scale (SSS) and the Glasgow Coma Scale (GCS). All survivors were reexamined 3 months after surgical decompression, with the clinical evaluation graded according to the Rankin Scale (RS) and Barthel Index (BI). We analyzed the influence of early decompressive surgery (<24 hours after symptom onset, based on clinical status at admission and initial CT findings) versus late surgery (>24 hours after first reversible signs of herniation) on mortality, functional outcome, and the length of time of critical care therapy was needed. RESULTS: In total, 46 patients (73%) survived. Despite complete hemispheric infarction, no survivor suffered from complete hemiplegia or was permanently wheelchair bound. In patients with speech-dominant hemispheric infarction (n=11), only mild to moderate aphasia was present. The mean BI score was 65, and RS score revealed severe handicap in 13% of the patients. In 31 patients with early decompressive surgery, mortality was 16% and BI score 68.8. Early hemicraniectomy led to a significant reduction in the length of time critical care therapy was needed (7.4 versus 13.3 days, P<0.05). CONCLUSIONS: In general, the outcome of patients treated with craniectomy in severe ischemic hemispheric infarction was surprisingly good. In addition, early decompressive surgery may further improve outcome in these patients.
Adult↗
MR appearance of an intracranial dural arteriovenous fistula leading to cervical myelopathy.
OBJECTIVE: To report the MRI, myelographic, and angiographic findings as well as the clinical and radiologic time course of an intracranial dural arteriovenous fistula (DAVF) leading to cervical myelopathy; and to review the pertinent literature. BACKGROUND: Cervical myelopathy from an intracranial DAVF draining into spinal medullary veins is extremely uncommon. However, knowledge about the MR features of these lesions is important because an improper diagnosis might result in delayed or incorrect treatment. METHODS: In a patient with progressive cervical myelopathy, T2- and proton density (PD)-weighted MRI, contrast-enhanced T1-weighted images, and a contrast-enhanced MR angiogram of the cervical spinal cord were acquired. Additionally, intraarterial digital subtraction angiography (DSA) of the right and left common carotid arteries was performed. RESULTS: MRI findings included swelling of the cervical spinal cord, hyperintensity of the cervical cord on T2- and PD-weighted MRI, and an enlarged vessel at the ventral surface of the cord on MR angiography. No parenchymal contrast enhancement of the spinal cord was noted on T1-weighted MRI. DSA revealed an intracranial DAVF fed by four branches of the left external carotid artery and draining into spinal medullary veins. The fistula was treated with endovascular embolization, leading to considerable clinical improvement of the patient. CONCLUSIONS: To avoid an improper diagnosis or a delayed or incorrect treatment of myelopathy resulting from an intracranial DAVF, cerebral intraarterial angiography may be indicated in cases of otherwise unexplainable cervical myelopathy.
Aged↗