Automatic Stroke Screening on Mobile Application: Features of Gyroscope and Accelerometer for Arm Factor in FAST.

This study focuses on automatic stroke-screening of the arm factor in the FAST (Face, Arm, Speech, and Time) stroke screening method. The study provides a methodology to collect data on specific arm movements, using signals from the gyroscope and accelerometer in mobile devices. Fifty-two subjects were enrolled in this study (20 stroke patients and 32 healthy subjects). Given in the instructions of the application, the patients were asked to perform two arm movements, Curl Up and Raise Up. The two exercises were classified into three parts: curl part, raise part, and stable part. Stroke patients were expected to experience difficulty in performing both exercises efficiently on the same arm. We proposed 20 handcrafted features from these three parts. Our study achieved an average accuracy of 61.7%-74.2% and an average area under the ROC curve (AUC) of 66.2%-81.5% from the combination of both exercises. Compared to the FAST method used by examiners in a previous study (Kapes et al., 2014) that showed with an accuracy of 69%-77% for every age group, our study showed promising results for early stroke identification, giving that our study is based only on the arm factor.

The lowest effective dose of botulinum A toxin in adult patients with upper limb spasticity.

OBJECTIVE: To define the lowest effective dose of botulinum toxin type A (Dysport) and safety in the treatment of adult patients with upper limb spasticity. DESIGN: This was a prospective, randomized, double-blind, dose-ranging study. Patients received either a placebo or one of three does of Dysport (350, 500 100) U) into five muscles of affected arm by anatomical and electromyography guidance. Efficacy was assessed periodically throughout the 6-month study period by the Modified Ashworth Scale (MAS), the Action Research Arm Test (ARA), the Barthel Index (BI) and the Visual Analogue Pain Scale (VAS). RESULTS: fifty patients were recruited. The four study groups were comparable at baseline with respect to their demographical characteristics and severity of spasticity. All doses of Dysport studied showed a significant reduction from baseline of muscle tone and pain compared to placebo. However, the effect of functional disability was best at a dose of 500 U and the peak improvement was at week 8 after injection. A dose of 1000 U Dysport produced such an excess degree of muscle weakening that the number of randomized patients was reduced to five. BI and ARA of all patients were decrease after injection. No other adverse event was considered related to the study medication. CONCLUSION: This study suggest that treatment with Dysport reduces muscle tone in adult patients with upper limb spasticity. The optimal dose for treatment of patients with residual voluntary movement in the upper limb appears to be 500 U.

Isolated corpus callosal infarction secondary to pericallosal artery disease presenting as alien hand syndrome.

Two patients are described with the callosal type of alien hand syndrome. Both presented with abnormal feelings in the left upper limb and intermanual conflict without clinical evidence of callosal apraxia or frontal lobe dysfunction such as motor deficit or reflexive grasping. Imaging studies disclosed subacute infarction in the body and splenium of the corpus callosum due to pericallosal artery disease. These patients were unique in their presentation as a callosal type of alien hand syndrome secondary to ischaemic stroke.

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.

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.

Magnetic resonance spectroscopy of the brain in neurologically asymptomatic HIV-infected patients.

The CNS involvement is frequently found in human immunodeficiency virus (HIV) infection. The purpose of our study was to determine whether proton magnetic resonance spectroscopy (MRS) could detect early brain involvement in neurologically asymptomatic HIV-infected patients with normal MR imagings and to find the correlation between MRS and the immune status. We performed MRS in 30 HIV seropositive neurologically asymptomatic patients with normal MRI and compared the MRS findings with 13 controls. A statistically significant reduction in N-acetylaspartate (NAA)/creatine (Cr) and N-acetylaspartate (NAA)/choline (Cho) in both centrum semiovale (p < 0.005) and thalamic areas (p < 0.05) was found. There is no statistically significant difference as to choline (Cho)/creatine (Cr) and myoinositol (mI)/creatine (Cr) ratios in both regions. The difference of NAA/Cr was more pronounced in the white matter than in the gray matter. As for the immune status, there was a trend towards correlation between CD4 counts and NAA/Cr but devoid of statistical significance. Our results suggest that MRS is more sensitive than conventional MR imaging in detecting CNS involvement in neurologically asymptomatic HIV patients and may, therefore, be used for early detection of brain damage induced by HIV.

Comparison of transcranial Doppler ultrasound and computed tomography angiography in symptomatic middle cerebral artery stenosis.

Transcranial Doppler ultrasound (TCD) and computed tomography angiography (CTA) of 10 patients with middle cerebral artery territory stroke were studied. To obtain data from patients with presumed in situ middle cerebral artery (MCA) stenosis, the study excluded patients with a known source of cardiac emboli, significant carotid stenosis and classical lacunar syndrome. As the gold standard for this study, CTA demonstrated MCA stenosis in all patients (100%), while abnormal TCDs suggesting MCA stenoses were found in only six patients (60%). The stenotic sites differed among patients with normal and abnormal TCDs. Patients with false negative TCDs were found to have more distal lesions (distal M1 or M2 segment) whereas patients with TCD abnormalities tend to have more proximal lesions as demonstrated by CTA. It is concluded that an abnormal TCD is highly suggestive of stenosis of MCA. A normal TCD, however, does not exclude such a lesion, especially in patients with distal M1 or M2 stenoses. Therefore, TCD may not be the best screening test for intracranial vascular stenotic lesion in MCA territory stroke.

Takayasu arteritis: ultrasonographic evaluation of the cervico-cerebral arteries.

PURPOSE: To present the ultrasonographic findings of the cervico-cerebral arteries in patients with Takayasu arteritis. MATERIALS AND METHODS: We used duplex ultrasound to study the arteries in the neck including the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and the vertebral arteries. For the intracranial arteries, transcranial Doppler ultrasound was used to study the blood flow velocities and directions in the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), ophthalmic artery, basilar and vertebral arteries. The ultrasonographic findings were compared with magnetic resonance angiography (MRA) and standard angiography. RESULTS: Four patients with the diagnosis of Takayasu arteritis were studied. One patient presented with ischemic optic neuropathy and was found to have absent radial pulse. Two patients presented with severe hypertension in young age. The other patient had accidental findings of unmeasurable blood pressure in both arms. One patient had abnormal carotid duplex ultrasound. He was found to have an occlusion of the right ICA. Thickening of the wall of the left ICA was also noted. Reduction of flow velocity in the MCA was demonstrated on TCD. There was evidence of collateral circulation from the contralateral carotid artery demonstrated by reversal of flow in the ipsilateral A1 segment of the ACA. MRA and angiography confirmed the ultrasound findings. Three patients had normal carotid duplex ultrasound but one of them was found to have a severe stenosis at the origin of the common carotid artery by MRA and angiogram. Absence of one vertebral artery was noted in three patients. MRA and angiogram confirmed the occlusion of the same vertebral arteries at their origins. In one patient, reversal of flow in the intracranial part (V4 segment) of the affected vertebral artery indicating collateral flow from contralateral vertebral and basilar arteries was demonstrated. CONCLUSION: Ultrasonography could be used as an additional noninvasive procedure apart from CT angiography, MRI and MRA in patients with Takayasu arteritis. Occlusion and wall thickening of the neck artery could be detected by color coded B-mode and Doppler ultrasound. Transcranial Doppler was useful in evaluation of flow velocity and flow direction of the arteries around the circle of Willis.