Clinical utility of brain computed tomography in prediction of post-stroke delirium.

Delirium is a common and serious complication of stroke. Early prediction of delirium is important for preventive strategies and close monitoring of high-risk patients. Pre-existing degenerative and vascular changes in the brain could predispose to delirium. We aimed to determine if computed tomography (CT)-based indices could provide additional information about a risk of stroke-associated delirium beyond easiest-to-access clinical predictors. Using semi-quantitative scales (global cortical atrophy, age-related white matter changes, and Scheltens scale), we assessed global and regional brain atrophy and white matter changes in 88 stroke patients with delirium and 142 patients without delirium matched for age and stroke severity. Patients with delirium had greater global and local brain atrophy (the right temporal region, the left parieto-occipital region, the right frontal and occipital horn, and the right and left temporal horn) than patients without delirium. Scores of white matter changes did not differ between groups with exception of greater white matter damage in the right parieto-occipital area in patients with delirium. The discriminatory properties of studied radiological indices were modest (areas under receiver operator curves: 0.58-0.64). CT-based indices of brain atrophy and white matter changes do not provide additional information about a risk of post-stroke delirium beyond the most important clinical predictors.

Computed Tomography Assessment of Brain Atrophy in Centenarians.

The aim of our study was to compare the degree of brain atrophy in centenarians and in seniors 70-99 years old. The study group consisted of 23 patients aged 100-106 years. The control group consisted of 90 patients, 30 in each age subgroup 90-99, 80-89, 70-79. In all the patients, the brain atrophy linear parameters were measured on computed tomography scans, in relation to both "subcortical atrophy", evaluated as progressive widening of the ventricular system, and "cortical atrophy", defined as widening of subarachnoid space. Secondary indices based on the parameters were calculated. Correlations between the above parameters/indices and age were tested. Significantly different values between the centenarians and the control group were found in the brain atrophy parameters: A, B, C, E, FI, ICR, ICL, SW, CFW, F/A 'frontal horn index', A/G 'Evans index', D/A 'ventricular index', H/E 'cella media Schiersmann index', A+B 'Huckman number'. Correlations between parameter/index and age were found for: A, B, C, FI, ICR, ICL, SW, F/A 'frontal horn index', A/G 'Evans index', D/A 'ventricular index', H/E 'cella media Schiersmann index', A+B 'Huckman number'. Brain atrophy associated with aging is a continuously advancing process, affecting centenarians even more than people before the "magic" threshold of 100 years.

The effect of software post-processing applications on identification of the penumbra and core within the ischaemic region in perfusion computed tomography.

PURPOSE: Assessment of software applications designed for post-processing of CT imaging data and perfusion maps in terms of their ability to consistently define the penumbra and core in an ischemic area. MATERIAL AND METHODS: This study is based on measurements conducted in a group of 65 patients with neurological symptoms suggestive of ischaemia in the area of the MCA within 12 hours following onset of the first symptoms. Non-contrast and perfusion CT were performed during an emergency duty. The acquired data were processed using various programs to obtain defined ischaemic areas and parameters. Finally, the results obtained were compared to the distribution of penumbra and core within the ischaemic area received from different perfusion mapping programs. RESULTS: The programs designed to convert the acquired data and to map the distribution of perfusion were also assessed for their viability in dividing the ischaemic zone into penumbra and core. There was a statistically strong correlation (0.784-0.846) between results obtained by processing of imaging data with two different packages, and then by post-processing with one package, and a poor correlation (0.315-0.554) between results obtained by processing of data with the same package, and post-processing with two different packages designed for measuring penumbra and core areas. CONCLUSIONS: The results obtained by processing of imaging data with different software applications and by post-processing with one program developed for identifying penumbra and core areas show a strong correlation. However, the results obtained by processing imaging data with the same software application and by post-processing with different programs measuring penumbra and core areas reveal poor correlation.

How to avoid false positive hyperdense middle cerebral artery sign detection in ischemic stroke.

OBJECTIVES: The aim of the study was to find how to differentiate hyperdense middle cerebral artery sign (HMCAS) in stroke patients from asymmetric hyperdensity not related to stroke, by comparison of the CT density values typical for HMCAS to the values in normal or atherosclerotic middle cerebral artery (MCA). METHODS: The group analyzed consisted of 100 patients with ischemic stroke, presenting HMCAS on the admission CT. Density measurements in HU were performed in the hyperdense segment of the involved MCA, contralateral MCA, brain cortex adjacent to the hyperdense MCA. The control group consisted of 100 patients with no symptoms of cerebral stroke. Density measurements in HU were performed: in the M1 segment of right and left MCA, brain cortex adjacent to the more dense from right or left MCA. RESULTS: In the stroke group the median values obtained were: in the hyperdense MCA 59 HU, contralateral MCA 41 HU, brain cortex 36 HU. In the control group the median values obtained were: in the more dense MCA 43 HU, contralateral MCA 40 HU, brain cortex 34 HU. The range of HMCAS/contralateral MCA density ratios in stroke only slightly overlapped the range of more dense MCA/contralateral MCA density ratios in non-stroke patients. CONCLUSION: The ratio of hyperdense MCA CT density/contralateral density is a good tool to differentiate HMCAS from asymmetric hyperdensity not related to stroke. The threshold ≥1.16 provided 100% sensitivity and 97% specificity, whereas ≥1.22 provided 94% sensitivity and 100% specificity.

Hyperdense middle cerebral artery sign as the only radiological manifestation of hyperacute ischemic stroke in computed tomography.

OBJECTIVES: The main aim of the study was to find the effect of hyperdense middle cerebral artery sign (HMCAS), as the only admission computed tomography (CT) manifestation of ischemic stroke involving middle cerebral artery (MCA) region, on the extent of stroke measured by Alberta Stroke Program Early CT score (ASPECTS) in the follow-up CT. The secondary aim was to determine the correlation between length of hyperdense MCA segment on admission CT and ASPECTS in follow-up CT. METHODS: The group analyzed consisted of 118 patients with ischemic MCA region stroke, with no early signs of brain tissue ischemia on admission CT, but infarcts confirmed in follow-up CT, with extent evaluated using ASPECTS. For the subgroups: 66 patients with HMCAS present and 52 with HMCAS absent, median ASPECTS values were compared. In the subgroup with HMCAS present, length of hyperdense segment was measured and correlation with ASPECTS was determined. RESULTS: The median ASPECTS 6 (min. 0, max. 9) in the subgroup with HMCAS present was significantly lower, compared to the score 8.5 (min. 0, max. 9) in the subgroup with HMCAS absent. Moderate correlation between the length of hyperdense segment and ASPECTS was found (R=-0.45). CONCLUSION: In patients with ischemic stroke involving MCA region and no early signs of brain tissue ischemia on the admission CT, HMCAS is associated with significantly lower ASPECTS in the follow-up CT. There is moderate correlation between the length of hyperdense MCA segment and ASPECTS.

[Results of cerebral angiography performed after neuroradiological indications in children with CNS diseases]. / Wyniki angiografii mózgowej wykonywanej u dzieci z chorobami OUN ze wskazan neuroradiologicznych.

INTRODUCTION: Despite of the constant progress in the imaging of vessels, cerebral angiography characterises with the best specificity and sensitivity in detection of arterial, arteriovenous malformations and aneurysms. THE AIM: The aim of this study was to compare the results of cerebral angiography and other neuro-radiologic methods in cases suggesting the probability of vascular malformations in children with neurologic syndroms. MATHERIAL AND MEHTODS: In the year 2006 cerebral angiography was performed in 20 children since it was advised after radiological examinations in children hospitalized in the Department of Pediatric Neurology UJ CM in Krakó w. The group of children aged 3-17 years (mean 11 years) consisted of 11 girls and 9 boys. The commonest clinical diagnoses were epilepsy, less common cranial neuropathies, migraine, hemiparesis and agiomatosis of skin. Before cerebral angiography was indicated, other radiological examinations were performed, within CT in 7 cases, CTA in one, MRI in 17 children and MRA in 5. In some children other examinations were also performed, within transcranial doppler evaluation of cerebral blood flow, EEG, video EEG, lumbar puncture and ultrasound eye evaluation. RESULTS: The pathological changes were detected in 5 CT examinations, 1 CTA, 7 MRI and in 4 MRA, suggesting cerebral vascular malformations. Cerebral angiography excluded vascular malformations in 15 children. In 5 children angiography confirmed however the presence of vascular pathology. In 2 of them arterial hypoplasia in the posterior circulation was detected, in 2 cases supratentorial artery hypoplasia and a single venous cerebellar malformation. Children were diagnosed with migraine with aura in two cases, within one with paresis of the right leg and single cases with skin angiomatosis, syncope and sleep myoclonus. CONCLUSIONS: Cerebral angiography allowed to exclude vascular pathology in 75% of children, in whom previous neuroradiological examinations suggested such pathology. It was important for their quality of life. In 25% of patients angiography confirmed results of previous neuroradiological tests detecting vascular pathology. MR with contrast medium is more sensitive than angiography in detection of venous angiomas.

[Trigeminalgia caused by neurovascular compression in 12 years old girl]. / Trigeminalgia z konfliktu naczyniowo- nerwowego u 12-letniej dziewczynki.

Trigeminalgia is one of the most frequent clinical problems, common in adults but also found in children. In this paper we described a case of 12 years old girl with symptomatic trigeminalgia caused by neurovascular compression, hospitalized in the Department of Pediatric Neurology Jagiellonian University in Kraków. It creates a very difficult diagnostic problem. The girl was first unsuccessfully treated with carbamazepine and afterwards the surgery of neurovascular decompression was performed. We emphasis the crucial role of MR and MRA in cases refractory to classic pharmacotherapy.