Early Diagnosis of Acute Ischemic Stroke by Using 16 row Multi-slice Computed Tomography

PURPOSE: Conventional spiral computed tomography (CT) has a limitation in the diagnosis of the early phase of cerebral ischemia because ischemic signs may be subtle or even not detectable. The authors carried out this study in order to determine the value of 16 row multi-slice CT (MSCT) in the clinical study of patients with acute stroke. METHODS: Between June 2002 and May 2003, we performed MSCT on 18 consecutive patients who presented within 6 hours of onset of signs and symptoms suggesting stroke. We used an imaging protocol with 3 components, noncontrast CT, perfusion CT, and CT angiography, to evaluate hyperacute stroke patients. In order to evaluate it' s validity, we compared MSCT with MRI. RESULTS: Perfusion parameter maps such as cerebral blood flow, cerebral blood volume, and time to peak showed perfusion deficits in 14 of 18 patients. Perfusion deficits in two patients with brain stem infarcts and in one patient with a lacunar infarct were missed. Hemispheric territorial infarcts were diagnosed with a sensitivity of 93% (14 of 15 patients). MSCT has a significantly shorter interval between the patient's arrival and taking an image (23.1+/-13.3 vs 52.7+/-21.8 minutes, p=0.0001) and a significantly shorter scanning time (13.7+/-2.5 vs 26.8+/-11.2 minutes, p=0.0003) than MRI does. CONCLUSION: In hyperacute stroke, MSCT not only allows early detection of cerebral ischemia but also yields valuable information about the extent of perfusion disturbances. Compared with MRI, MSCT is a more readily available, less time consuming procedure. MSCT may help in therapeutic decision-making if perfusion and diffusion-weighted MRI are not available or cannot be performed on specific patients.

Clinical Implication of Pelvic Ring Disruption in Blunt Trauma

PURPOSE: Existing classifications on types of pelvic fractures in current use usually are orthopedic treatment oriented and depend on the results of late examinations, such as CT scans, in which differentiation of early diagnosis is difficult. The authors carried out this study in order to provide early assessment concerning the prognosis of emergent pelvic fracture patients to classify the type of pelvic fracture by using the Young classification method obtained through an early pelvis AP view study. METHODS: We performed a retrospective review of 89 patients with pelvic bone fractures seen at our hospital between March 2001 and February 2003. The patients were divided into two groups (simple pelvic fracture and pelvic ring disruption) according to the type of injury. We compared clinical data such as age, vital signs, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and initial hemoglobin between the two groups. We also compared associated abdominal or urogenital injuries and extra-pelvic injuries between the two groups. RESULTS: Patients with pelvic ring disruption (n=51) had lower blood pressures ( p=0.003), higher pulse rates (p=0.017), higher RTSs ( p=0.034), and higher ISSs (p=0.019) than those with a simple pelvic fracture (n=38). A comparison of associated injuries between the two groups showed that patients with a pelvic ring disruption had higher incidences of retroperitoneal hematoma (p=0.026), urogenital injury (p=0.003), and thoracic injury (p=0.019) than those with a simple pelvic fracture. CONCLUSION: The pelvic ring disruption group showed more unstable hemodynamic changes together with higher incidences of associated injuries than the simple pelvic fracture group. Therefore, early classification by means of the Young method is considered to be beneficial in the treatment of and in the assessment of the prognosis for pelvic fracture patients at an emergency center.

Nontraumatic Spontaneous Cervical Epidural Hematoma

Nontraumatic spontaneous spinal epidural hematoma is a rare entity, which can be associated with a severe neurologic deficit. The presenting symptoms are usually back or neck pain, either local or radicular, followed by progressive bilateral weakness, and sensory loss hours and even days later. In the absence of precipitating factors such as severe trauma or known coagulopathy, the diagnosis may be delayed. Imaging, including cervical CT or MRI, may play an essential role for the prompt diagnosis and differentiation from other cervical pathologies. With a full review of the literature, we report and discuss a case of nontraumatic cervical epidural hematoma in which a 67-year-old female visited the emergency center for neck and right shoulder pain. She experienced a complete recovery after conservative treatment only.