ABSTRACT
BACKGROUND: In gradient echo magnetic resonance imaging (MRI), intravascular thrombi (IT) can appear as vascular susceptibility artifacts, linked to local presence of intra-arterial deoxyhaemoglobin, and called susceptibility vessel signs (SVS). AIMS: Our objectives were to evaluate the sensitivity of susceptibility-weighted sequences, such as T2* weighted angiography (SWAN) in the visualization of SVS compared with T2*, to consider whether it enabled a better understanding of the importance of SVS, and to compare cerebral circulation regulation profiles according to the localization of the SVS (i.e. proximal or distal). METHODS: We prospectively studied the clinical and imaging data of 78 consecutive patients admitted for acute cerebral ischemia to the stroke unit of Besançon University Hospital between 1 April 2009 and 31 January 2010. RESULTS: An SVS was visualized in 44/78 (56%) patients using SWAN and in 13/78 (16%) patients using T2*. All the SVS visible using T2* were also visible on the SWAN. The inter-observer kappa score was 0·72 [CI (0·53-0·91)] for T2*, 0·72 [CI (0·57-0·87)] for SWAN, and weighted kappa was 0·77 [CI (0·61-0·92)] for both T2* and SWAN. When an MCA occlusion was visible on MRA imaging (22/78 patients), a SVS was visualized in 7/22 cases (31·8%) using T2* and in 20/22 cases (91%) using SWAN. When the occlusion was visible in the M1 or M2 segments (17/78 patients), an SVS was visualized in 6/17 cases (35·3%) using T2* and in 15/17 cases (88·2%) using SWAN. When the occlusion was visible in the M3 segment (5/78 patients), an SVS was visualized in 1/5 cases (20%) using T2* and in 5/5 cases (100%) using SWAN. Presence of SVS was not associated with cardioembolic etiology of the stroke. CONCLUSIONS: SWAN was more sensitive than T2* in the visualization of SVS in the intracranial arteries during the acute phase of ischemic stroke. Our study shows that the low number of SVS visualized using T2* in previous studies is probably related to a lack of sensitivity of the sequence, rather than to the nature or age of the thrombus. The greater sensitivity of SWAN seems to be linked to the visualization of SVS in cases of small thrombi.
Subject(s)
Brain Infarction/diagnosis , Magnetic Resonance Imaging , Stroke/drug therapy , Stroke/pathology , Thrombosis/pathology , Brain Infarction/etiology , Brain Ischemia/complications , Female , Hemoglobins/metabolism , Humans , Magnetic Resonance Angiography , Male , Prospective Studies , Radiography , Retrospective Studies , Sensitivity and Specificity , Stroke/etiology , Thrombosis/diagnostic imagingABSTRACT
INTRODUCTION: Cerebral vasculitis is a rare and severe condition, posing problems for diagnosis and treatment. Toxocara canis cerebral vasculitis is exceptionally rare, with only 4 cases having been reported. We report an additional case revealed by iterative strokes. OBSERVATION: A 49-years-old Laotian man presented with right ACA infarction associated with contrast enhancement of cerebrospinal fluid, and multiple segmental stenoses in small and medium caliber encephalic arteries, in a context of hypereosinophilia and chronic headaches. Laboratory tests showed lymphocytic meningitis and T. canis antibody IgE in the blood and CSF. The diagnosis of T. canis cerebral vasculitis was retained. During follow-up, the patient presented again with left pontine hemorrhagic stroke. Conventional cerebral angiography confirmed progression of vasculitis despite treatment. CONCLUSION: This case-report illustrates the diagnostic and therapeutic difficulties associated with vasculitis.
Subject(s)
Stroke/etiology , Toxocara canis , Toxocariasis/complications , Vasculitis, Central Nervous System/etiology , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Cerebral Angiography , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/parasitology , Headache/etiology , Humans , Immunoglobulin E/blood , Immunoglobulin E/cerebrospinal fluid , Immunoglobulin E/immunology , Infarction, Anterior Cerebral Artery/drug therapy , Infarction, Anterior Cerebral Artery/etiology , Infarction, Anterior Cerebral Artery/parasitology , Magnetic Resonance Imaging , Male , Middle Aged , Pons/pathology , Stroke/parasitology , Toxocariasis/drug therapy , Toxocariasis/parasitology , Vasculitis, Central Nervous System/drug therapy , Vasculitis, Central Nervous System/parasitologyABSTRACT
INTRODUCTION: The aim of our study was to compare the efficacy and safety of intravenous thrombolysis of cerebral ischemia as it has been established in a distant hospital (DH) through telemedicine tools or in neurovascular unit of the University Hospital of Besançon. METHOD: Our work was conducted retrospectively at the University Hospital of Besançon from 1 January 2003 to December 31, 2009. RESULTS: Fibrinolysis was introduced at the university hospital in 98/161 patients (61%) and a DH in remote 63/161 patients (39%). A favorable neurological outcome (Rankin 0/1) was observed in 27/98 patients (27.5%) treated at University Hospital and in 25/63 (39.5%) patients in a DH. There was no significant difference between the two subgroups. Symptomatic hemorrhagic transformation occurred in 5/98 (5%) patients treated at University Hospital and in 1/63 (1.5%) patients treated in DH. There was no significant difference between the two subgroups. CONCLUSION: Our study shows that fibrinolysis remotely using the tools of telemedicine has, from 2003 to 2009, in Franche-Comté deal effectively and without risk of a significant proportion of patients.
