Do early ischemic changes on computed tomography predict the stroke severity and functional outcome in patients with acute ischemic stroke?

Computed Tomography [CT] is available in all stroke centers and can be interpreted by all radiologists and even by trained neurologists. The study aim was to test the association of early ischemic changes [EICs] on initial CT with different variables especially the stroke severity and the functional outcome. Retrospective analysis of 118 patients [aged 70.2 +/- 11.9 years [mean +/- SD]; 45% females] with middle cerebral artery [MCA]-stroke treated with intravenous recombinant tissue plasminogen activator [rtPA] at the neurology department of our university hospital May 2004-May 2008. Out of 118 patients, 52 [44.1%] showed EICs. Of 52 with EICs: 50 [96%] developed MCA infarction [P<0.001], 11 [21%] had altered consciousness [P=0.032], and 20 [38%] were institutionalized three months after stroke [P=0.024]. Similarly patients with EICs sustained larger infarcts [infarct volume 79 cm[3]] than patients with no EIC [infarct volume 22 cm[3]]; P<0.001. The total time between the stroke onset and initiation of thrombolysis therapy was shorter in patients with EICs than in those with no EICs [109 vs. 124 minutes]; P=0.016 Excluding the hyperdense middle cerebral artery sign [HMCAS], the difference in the functional outcome in patients with other EICs was not statistically significant compared with that in patients with no EICs [P=0.214]. However, patients with EICs other than HMCAS showed to have more severe stroke [mean NIHSS on admission: 14.5] than those with no EICs [mean NIHSS on admission: 11.5], P=0.036. The difference between the NIHSS at 24 hours' control was also statistically significant when comparing the two groups [11.3 in patients with EICs vs. 6.8 in patients with no EICs], P=0.025. EIC showed to be associated with severe stroke and poor functional outcome. Excluding HMCAS, other EICs are only associated with development of sever stroke

Recent advances in the radiological workup of acute ischemic stroke

Acute stroke is one of the leading causes of mortality and morbidity in adults. The first step in the management of stroke is the establishment of correct diagnosis. Computed Tomography [CT] is the method of choice in the initial workup of acute stroke. However the introduction of multidetector CT and new generations of Magnetic Resonance Imaging [MRI] has made it possible to perform dynamic and functional analysis of cerebral circulation beside the improvement in the morphological assessment of brain parenchyma and cerebral vessels. The aim of this paper is to review the modern radiological modalities used in the investigation of acute ischemic stroke, enriched with genuine image gallery

MRI findings in patients with neurogenic claudication suspected to have central lumbar spinal stenosis

Central lumbar spinal stenosis [CLSS] presents as neurogenic claudication. CLSS can also be found radiologically in asymptomatic patients. The major aim of this study was to comprehensively analyze MRI-findings in patients with neurogenic claudication. MRI of 64 consecutive patients [average age of 63.5 +/- 14 year [Mean +/- SD], 34 patients [53%] were female] with suspected spinal claudication was included in this retrospective analysis. CLSS was considered to be present whenever dural sac had an AP-diameter < 10 mm and cross-sectional area

Diffusion weighted imaging in acute stroke and stroke mimics: reliability analysis, radiological findings and clinical significance

To assess the reliability and to determine the sensitivity and specificity of Diffusion Weighted Images [DWI] in detection of acute infarcts in patients whose initial CT and conventional MR-sequences did not explain the patients stroke symptoms. The second aim was to find out if DWI provides additional information when it was performed within 2 days of onset of symptoms. MRI and DWI of 59 consecutive patients [66% were male; aged 60 +/- 14 year [Mean +/- SD]] admitted with stroke and stroke like episodes were retrospectively analyzed. The images were independently evaluated by two neuroradiologists. DWI showed acute infarct in 25 patients [42%]. Hemiplegia and dizziness were the most common symptoms in patients with positive and negative DWI, respectively. Lacunar infarcts near the motor cortex were the most common type of infarcts detected by DWI. DWI provided additional information in 89% of patients when performed within 2 days of ictus compared 31% in patients examined =2 days after ictus [Fisher's exact test, P 0.011]. DWI provided relevant information in 26% of patients despite negative DWI. The specificity and sensitivity of DWI in acute stroke was 100% and 89% respectively. DWI is a reliable MR-sequence in the workup of acute and subacute stroke. DWI helps to differentiate acute infarcts from other white matter changes seen on conventional MRI-sequences. In patients with stroke like episodes, a negative DWI provides relevant clinical information and help in future clinical management

CT-angiography and doppler ultrasonography in atherosclerotic carotid artery disease: a comparative study

Different diagnostic modalities to investigate atherosclerotic carotid artery disease [ACAD] are nowadays available. The aim of this study was to test the concordance of the findings of the two most widely used diagnostic modalities namely computed tomography angiography [CTA] and doppler ultrasonography [DUS]. 29 patients with acute ischemic stroke were subjected to CTA and DUS and included in this analysis; 17 patients were males [59%]. The mean age was 70.5 +/- 8 years [Mean +/- SD]. The correlation and the degree of concordance between the findings of CTA and DUS were tested. The associations between the occurrence of ACAD and the degree of severity of stenosis with the age, the gender and the side of stenosis were also tested. The statistical significance was set to < 0.05. This study showed almost perfect agreement between CTA and DUS in detection of stenosis with kappa value of 0.92 [95% CI 0.82-1.02]. Intraclass correlation coefficient for the agreement between CTA and DUS in the estimation of the degree of stenosis was almost perfect and estimated to 0.96 [95% CI 0.93-0.97]. The differences of the measurements of the degree of carotid artery stenosis by the two methods was not statistically significant [p=0.04] with random error of 9.9%. Spearman's correlation and linear regression showed strong correlation between the measurements of stenosis by CTA and DUS with P< 0.001, correlation coefficient of 0.933, and R2 linear of 0.92, respectively. The stenosis was more severe in males. CTA and DUS are non-invasive diagnostic modalities with good correlation with regard to the detection of ACAD and the estimation of the degree of stenosis and can be used separately or as complementary to each other in the work-up of ACAD