Comparison of CT and DWI findings in ischemic stroke patients within 3 hours of onset.

This study compared the detection rate of ischemic lesions within 3 hours of onset by computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI). The study group comprised 130 patients (71 men; median age, 75 years) with an anterior territory stroke who underwent CT and DWI within 3 hours of onset. The lesions revealed on CT and DWI were assessed using the CT-Alberta Stroke Program Early CT Score (ASPECTS) and DWI-ASPECTS, and detection rates were compared for each ASPECTS region. The detection rate of ischemic lesions was higher on DWI than on CT (76.9% v 30.0%; P < .001). The DWI-ASPECTS score was not correlated with the CT-ASPECTS score (r = 0.51; P < .001). Ischemic lesions were detected in the insula (59.2% for DWI vs 15.4% for CT; P < .001), lentiform nucleus (43.8% v 20.0%; P < .001), and the M1 (30.8% v 6.9%, P < .001), M2 (50.8% v 6.2%; P = .006), M3 (28.5% v 3.1%; P = .006), M4 (32.3% v 6.9%; P < .001), M5 (48.5% v 10.8%; P < .001), and M6 (31.5% v 4.6%, P = .012) areas of the middle cerebral artery. DWI detected ischemic lesions significantly more frequently than CT in all ASPECTS regions except the caudate head and internal capsule.

Vascular corticobasal syndrome caused by unilateral internal carotid artery occlusion.

A 65-year-old man developed progressive worsening of right-sided limb-kinetic apraxia and extrapyramidal dysfunction. His left internal carotid artery was found to be occluded, and there was general atrophy and severely decreased cerebral blood flow in the left hemisphere. He had experienced an acute infarction in the left watershed area before superficial temporal artery to middle cerebral artery bypass surgery. After surgery, the cerebral blood flow in the left hemisphere was remarkably improved. Unilateral internal carotid artery occlusion may result in clinical manifestations similar to corticobasal degeneration.

A case of stroke due to tumor emboli associated with metastatic cardiac liposarcoma.

Cardioembolic stroke due to tumor emboli is a rare complication of neoplasm. A patient with metastatic cardiac liposarcoma who suffered from embolic stroke is reported. Autopsy confirmed that the cardiac tumor was a metastatic liposarcoma from the retroperitoneum, and the cerebral vessel was occluded by tumor cells and fibrin clot.

Wrong-way deviation: contralateral conjugate eye deviation in acute supratentorial stroke.

BACKGROUND AND PURPOSE: Supratentorial stroke can cause conjugate eye deviation directed contralateral to the affected side (wrong-way deviation). It is rare and thought to be associated exclusively with hemorrhagic stroke. We prospectively investigated the clinical features and prognostic significance of this wrong-way deviation. METHODS: Subjects were 12 patients who manifested wrong-way deviation subsequent to supratentorial stroke. These patients were from a group of 968 consecutive patients hospitalized for acute supratentorial stroke during the period April 2007 through March 2010. Clinical features of wrong-way deviation were evaluated. RESULTS: The overall incidence of wrong-way deviation was 1.2%. The causative lesion was a huge intracranial hemorrhage (n=7) or an extensive hemispheric infarction (n=5). Left-sided lesions were most frequent (66.7% of patients). Wrong-way deviation usually appeared a few days after the initial insult and was frequently accompanied by transient downward eye deviation (58.3% of patients). Although the outcomes for patients treated conservatively were generally poor, patients who underwent surgical decompression regained consciousness. CONCLUSION: Wrong-way deviation can result not only from hemorrhagic but also ischemic stroke if the stroke is extensive. Secondary damage to the adjacent rostral brainstem where oculomotor pathways cross over from the contralateral hemisphere can explain the phenomenon, its temporal evolution, and associated eye signs. Immediate surgical decompression may be necessary to improve the prognosis in such cases.