Computed tomographic findings in non-traumatic hemorrhagic stroke.

OBJECTIVE: To analyze CT findings in hemorrhagic stroke patients correlation with clinical outcome and assess the interobserver agreement of hemorrhagic stroke identification on CT imaging. MATERIAL AND METHOD: CT imaging features of 131 cases and clinical data were verified and collected at Siriraj Hospital from Jan 2004 to Dec 2005 and retrospectively analyzed for type, location, mass effect, size of hemorrhage, intraventricular extension, initial level of consciousness (GCS), hospital length of stay and patient outcome. The percentages, predictive values, kappa were calculated. RESULTS: From all types of hemorrhagic stroke, intracerebral hemorrhage remains a common and devastating clinical problem. The most common site was the thalamus and basal ganglia. In the present study, the authors found that fifty-three cases (53/131 cases, 40.5%) with thalamic-ganglionic hemorrhage, nineteen cases (19/131 cases, 14.5%) in lobar hemorrhage, five cases (5/131 cases, 3.8%) in cerebellum, five cases (5/131 7 cases, 3.8%) in brainstem and eight cases (8/131 cases, 6.1%) occurred in multiple locations. There were twenty-five cases (25/131 cases, 19.1%) of subarachnoid hemorrhage, thirteen cases (13/131 cases, 9.9%) of subdural hemorrhage and three cases (3/131 cases, 2.3%) of intraventricular hemorrhage. Two variables on CT imaging, identified as significant as early mortality predictors, were hematoma volume more than 60 cm3, and presence of intraventricular hemorrhage extension (p < 0.05). The mass effect defined as midline and/or enlargement of contralateral ventricle was not significant (p = 0.067). The present study found concordance between CT brain interpretation by two neuroradiologists for the type of hemorrhagic stroke was very good, Kappa = 0.861 as well as for location was 0.866. CONCLUSION: CT imaging is an imaging instrument for early identification of hemorrhagic stroke patients and providing imaging evidence of high mortality risk.

Stroke in Henoch-Schönlein purpura associated with methicillin-resistant Staphylococcus aureus septicemia: report of a case and review of the literature.

Neurological involvement in Henoch-SchOnlein purpura (HSP) such as stroke is uncommon manifestiation, particularly in association with Staphylococcus aureus (S. aureus). The authors reported a 17-year-old man who developed sudden onset of right hemiparesis while he was admitted in the hospital about his prolonged fever, palpable purpura and upper gastrointestinal bleeding. He also had evidence of MRSA septicemia before the onset of right hemiparesis. Skin biopsy was done and showed that there was leukocytoclastic vasculitis with IgA deposition. He had received completed course of antibiotics and then he was subsequently improved after steroid therapy in the next 2 weeks. Review of case reports from previous English literatures, discovered the association between MRSA infection and HSP which can cause several CNS manifestations including stroke symptoms from cerebral vasculitis.

Imaging findings of CNS lymphoma in Siriraj Hospital.

Objective: To describe the CT and MR features of CNS lymphoma (both PCNSL and SLCNS groups) and to determine whether there is a difference. Methods: A retrospective study of CNS lymphoma in 100 patients at the department of Medicine, Siriraj Hospital, Mahidol University, during January 1997 – September 2002, for neuroimaging analysis. We retrospectively analyzed all available CT and MR findings of these patients by a neuroradiologist who was blinded to the patients’ clinical histories. The imaging studies were evaluated for density in CT, intensity in MR, pattern of enhancement, leptomeningeal enhancement, number of lesions, location and degree of edema. For MRI of spines, we additionally classified 4 menifestations: osseous lymphoma, spinal epidural lymphoma, lymphomatous meningitis and intramedullary lymphoma. Results: Only 33 CTs of the brain, 12 MRs of the brain and 11 MRs of spines were available for retrospective evaluation in this study. For CTs of the brain, most of the lesions showed hyperdensity on non-contrast CT (45% in PCNSL and 59% in SLCNS) with homogenous enhancement on contrast CT (78% in PCNSL and 75% in SLCNS). Eleven percent of ring enhancement lesions in PCNSL and eight percent in SLCNS were found in all patients with HIV infection. For MRs of the brain, most lesions of PCNSL and SLCNS showed hypo-isointensity in both T1W and T2W and homogenous enhancement. Locations of PCNSL were found in cerebral white matter and corpus callosum (55.5%) and basal ganglia (33.3%). SLCNS were found in cerebral white matter (50%), cavernous sinus (37.5%), basal ganglia (6.25%) and brainstems (6.25%). Conclusion: CNS lymphoma has been increased in Thailand. Imaging findings in PCNSL and SLCNS groups were not difference in this study. The pattern of imaging findings of CNS lymphoma in Thailand was similar to CNS lymphoma in the world.

Hemifacial spasm treated with botulinum toxin injection: A ten-year experience at Siriraj Hospital.

Background : Hemifacial spasm is a common movement disorder in Thailand. Botulinum toxin has been introduced as an advanced treatment for this condition recently. Objective: To evaluate the efficacy and complication of botulinum toxin in the treatment of hemifacial spasm. Methods: We reviewed all files of patients with hemifacial spasm in the Movement Disorders Clinic at Siriraj Hospital, Mahidol University, who were treated with botulinum toxin injection from January, 1989 until September, 1999. Sex, age, duration of treatment, times of injection, treatment outcome, and complications were analysed. Results: There were 913 patients of which 38 patients were excluded because they were loss to follow up. 875 patients were analysed, (269 males, 606 females sex ratio 1:2.25). The mean age of all patients was 50.86+12.53 years with a range of 18 to 81 years. The follow up period ranged from 1-130 months (mean = 32.5+35.05 months). The outcome were classified as excellent (improvement >50%) in 58.9%, good (improvement >25%) in 37.3%, fair (improvement <25%) in 3.1%, and no improvement in 0.8%. Thus the efficacy of this treatment (improvement >25%) was 96.2 percent. There were complications of mild facial paresis in 80 patients (9.1%), ptosis in 39 patients (4.5%), excessive lacrimation in 7 patients (0.8%), and others (including pain and itching at the injection sites and double vision) in 7 patients (0.8%). All of the complications ere transient. ? Conclusion: Botulinum toxin A injection is a safe and effective way with no long term systemic complications (of treating patients with hemifacial spasm).