A perplexing case report of an imaging negative acute ischemic stroke

Magnetic resonance imaging (MRI) is often seen as the gold standard when dealing with an acute ischemic stroke. Despite its unique ability to quickly diagnose acute stroke with diffusion-weighted imaging, there is enough evidence to suggest that MRI has failed to diagnose acute ischemic stroke in a minority of patients. We, hereby, present a case of a 55-year-old gentleman who presented with symptoms consistent with an acute ischemic event, but concurrent computed tomography and MRI were normal. However, the treatment regime for stroke was commenced despite normal imaging. It was only on the 3rd day of admission when the MRI revealed a significant finding which consolidated our diagnosis of ischemic stroke.Through this case report, we aim to help clinicians avoid misdiagnosis or delay in the treatment strategies, especially intravenous thrombolysis in patients with a clinical diagnosis of acute stroke with normal neuroradiological imaging. This is a testament to the fact that clinical assessment still retains priority until a diagnostic tool offers 100% sensitivity and specificity

Migraine With Aura Presenting Reversible Delayed Perfusion

It is believed that migrainous aura is correlated with cortical spreading depression and spreading benign oligemia. A 54-year-old female with migraine with aura presented with left hemianopia preceding pulsating headache. Perfusion-weighted images revealed delayed contrast arrival to the right occipital lobe and nearly normal relative cerebral blood volume images, indicating benign oligemia. Follow-up perfusion-weighted images revealed resolution of the perfusion abnormalities. We report herein a case of migraine with aura presenting with reversible delayed perfusion in the right occipital lobe on perfusion-weighted images.

Study on the relationship between the change of MRI perfusion imaging and NF-kB expression in perihematoma region inchemic reperfusion after intracerebral hemorrhage / 临床神经病学杂志

Objective To study the relatinonship between the regional cerebral blood flow (rCBF) and NF-kB expression in perihematoma region after intracerebral hemorrhage (ICH).Methods 27 healthy dogs were divided into control group (3 cases) and ICH group (24 cases) at random. The models of ICH were made by injecting self-blood into the frontal lobes. At different points (3 h, 6 h, 12 h, 24 h, 48 h, 72 h, 7 d and 15 d), the changes of rCBF in the region of perihematoma were observed by perfusion weighted imaging (PWI). Immunohistochemistry SP method was used to detect expressions of NF-kB. Immune positive cells were stained brown-yellow colour in the cytoplasm and/or nucleus, and NF-kB positive particles that transformed from cytoplasm to nucleus showed activation of NF-kB. Results In the region of perihematoma, PWI showed hypo-perfusion within 12h, reperfusion or hyper-perfusion from 12 to 24 h, and slightly hypo-perfution after 48h. NF-kB positive cells presented at 6 h, reached the peak from 12 to 48 h, decreased from 72 h to 7 d, nearly disappeared at 15 d. NF-kB positive cells mainly existed in the region of perihematoma. From 12 to 48 h, NF-kB expression was markedly in quantities of neurons and gliacytes. The activated NF-kB was clearly shown at the same time.Conclusions Cerebral ischemia and reperfusion in the region of perihematoma could induce expression of NF-kB, which was involved in the inflammatory and immune reaction and resulted in the ingury caused by cerebral ischemia and reperfusion.