Thrombolytic treatment for acute ischemic stroke: a 2 year-experience at King Chulalongkorn Memorial Hospital.

We studied 9 stroke patients who received a thrombolytic agent at King Chulalongkorn Memorial Hospital. Six presented with stroke in the middle cerebral artery territory and three had basilar stroke. Seven patients were given intravenous thrombolysis and 2 received intra-arterial treatment. We strictly followed the inclusion and exclusion criteria for intravenous tissue plasminogen activator (rt-PA) according to the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA study. For patients receiving intraarterial thrombolysis, emergency angiograms were performed. Two patients with severe basilar stroke dramatically improved after intravenous thrombolysis and had very good outcome. Four patients with middle cerebral artery stroke became worse within 24 hours. Three of them died in the acute phase due to intracerebral hemorrhage (2 cases) and massive infarction with brain herniation (1 case). For intra-arterial treatment, good recanalization was seen but clinical improvement was insignificant. The result of thrombolytic treatment in this study was not so impressive, partly because we only treated the very severe cases. The efficacy of this treatment among our population needs to be further investigated.

Intracranial lymphoma: CT and MR findings.

The purposes of the present study were to describe CT and MR findings of intracranial lymphoma, to define imaging characteristics of primary and secondary intracranial lymphomas, and to compare CT and MR findings in the same patients. CT and MR studies of 26 patients with the diagnosis of intracranial lymphoma at King Chulalongkorn Memorial Hospital from 1988 to 2000 were reviewed. There were 22 cases of primary lymphoma (21 non-AIDS and 1 AIDS) and 4 cases of secondary lymphoma. Fifty-eight lesions were found. In primary lymphoma, most lesions were in the periventricular areas, appearing as multiple large well-defined margin masses with minimal surrounding edema and dense homogeneous enhancement on both CT and MR studies. The masses were hyperdense on CT scan, isointense on T1W images, and hyperintense to gray matter on T2W MR images. In one AIDS patient, rim enhancement of the lesion was found. Other uncommon findings included intratumoral hemorrhage, isolated mass in the brain stem and extracerebral locations. In secondary lymphoma, smaller and more lesions were noted. Diffuse ependymal enhancement was demonstrated in one case. The results suggest that MRI is more sensitive than CT scan in detecting intracranial lesions of lymphoma.