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https://www.readbyqxmd.com/read/28810259/reliability-reproducibility-and-prognostic-accuracy-of-the-alberta-stroke-program-early-ct-score-on-ct-perfusion-and-non-contrast-ct-in-hyperacute-stroke
#1
Jillian Naylor, Leonid Churilov, Ziyuan Chen, Miriam Koome, Neil Rane, Bruce C V Campbell
BACKGROUND: Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic change on non-contrast CT (NCCT). We hypothesised that assessing ASPECTS regions on CT Perfusion (CTP) rather than NCCT would improve inter-rater agreement and prognostic accuracy, particularly in patients presenting early after stroke onset. METHODS: Ischemic stroke patients treated with intravenous alteplase from 2009 to 2014 at our institution were included in this study. Inter-rater agreement and prognostic accuracy of ASPECTS across modalities were analysed by the time between stroke onset and initial NCCT, dichotomized 1st quartile versus quartiles 2-4, referred to as epochs...
August 16, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28804679/time-to-neurological-deterioration-in-ischemic-stroke
#2
James E Siegler, Karen C Albright, Alexander J George, Amelia K Boehme, Michael A Gillette, Andre D Kumar, Monica Aswani, Sheryl Martin-Schild
BACKGROUND: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke. The timing of ND with respect to ND etiology and reversibility has not been investigated. METHODS: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility. ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion...
2017: Medical Student Research Journal
https://www.readbyqxmd.com/read/28803639/atrial-fibrillation-and-stroke-as-initial-manifestations-of-painless-type-a-aortic-dissection
#3
Claudia Stöllberger, Lilian Schäffl-Doweik, Maria Korn, Josef Finsterer
Aortic dissection is diagnostically challenging, especially in pain-free patients. Detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians and neurologists. We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. Perfusion CT-imaging showed a dilatation of the aortic arch and intraluminal structures indicating an intima flap of aortic dissection...
July 21, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28802751/acute-management-of-hemostasis-in-patients-with-neurological-injury
#4
REVIEW
M Irem Baharoglu, Anneke Brand, Maria M Koopman, Marinus Vermeulen, Yvo B W E M Roos
Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults...
July 13, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28801174/the-cerebral-collateral-circulation-relevance-to-pathophysiology-and-treatment-of-stroke
#5
REVIEW
Myron D Ginsberg
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome...
August 8, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/28793822/dose-response-head-to-head-comparison-of-inodilators-dobutamine-milrinone-and-levosimendan-in-chronic-experimental-pulmonary-hypertension
#6
Marta Tavares-Silva, Mohamed Alaa, Sara Leite, José Oliveira-Pinto, Lucas Lopes, Adelino F Leite-Moreira, André P Lourenço
The choice of inodilator drug in the acute management of patients with pulmonary hypertension (PH) having right ventricular (RV) failure remains unsettled and challenging. Comprehensive experimental evaluations may provide further insight and fundamental translational research clues to support inodilator selection and clinical trial design. Our aim was to compare acute dose-response hemodynamic effects of inodilators dobutamine (DOB), milrinone (MIL), and levosimendan (LEV) in chronic experimental PH. Seven-week-old male Wistar rats were randomly injected with 60 mg·kg(-1) monocrotaline (MCT) or vehicle (Ctrl, n = 7) and underwent systemic and pulmonary artery (PA) pressure and RV pressure-volume (PV) hemodynamic evaluation under halogenate anesthesia 24 to 30 days after injection...
September 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28775139/permeability-surface-of-deep-middle-cerebral-artery-territory-on-computed-tomographic-perfusion-predicts-hemorrhagic-transformation-after-stroke
#7
Qiao Li, Xinyi Gao, Zhenwei Yao, Xiaoyuan Feng, Huijin He, Jing Xue, Peiyi Gao, Lumeng Yang, Xin Cheng, Weijian Chen, Yunjun Yang
BACKGROUND AND PURPOSE: Permeability surface (PS) on computed tomographic perfusion reflects blood-brain barrier permeability and is related to hemorrhagic transformation (HT). HT of deep middle cerebral artery (MCA) territory can occur after recanalization of proximal large-vessel occlusion. We aimed to determine the relationship between HT and PS of deep MCA territory. METHODS: We retrospectively reviewed 70 consecutive acute ischemic stroke patients presenting with occlusion of the distal internal carotid artery or M1 segment of the MCA...
August 3, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28767503/neuroendovascular-surgery-for-the-treatment-of-ischemic-stroke
#8
Arthur Wang, Meic H Schmidt
This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Advanced perfusion imaging helps identify patients with a low ratio of ischemic core to salvageable penumbra...
June 22, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28762565/influence-of-lung-volume-on-the-interaction-between-cardiac-output-and-cerebrovascular-regulation-during-extreme-apnoea
#9
Mike Stembridge, Ryan L Hoiland, Anthony R Bain, Otto F Barak, Ivan Drvis, David B MacLeod, Douglas M MacLeod, Dennis Madden, Tonci Batinic, Peter O'Donoghue, Rob Shave, Zeljko Dujic, Philip N Ainslie
We investigated the role of lung volume-induced changes in cardiac output (Q̇) on cerebrovascular regulation during prolonged apnoea. Fifteen elite apnoea divers (1F; 185 ± 7 cm, 82 ± 12 kg, 29 ± 7 years) attended the laboratory on two separate occasions and completed maximal breath-holds at total lung capacity (TLC) and functional residual capacity (FRC) to elicit disparate cardiovascular responses. Mean arterial pressure (MAP), internal jugular venous pressure (IJVP) and arterial blood gases were measured via cannulation, global cerebral blood flow (gCBF) was quantified by ultrasound and cardiac output via photoplethysmography...
August 1, 2017: Experimental Physiology
https://www.readbyqxmd.com/read/28760084/optimal-dilution-of-contrast-medium-for-quantitating-parenchymal-blood-volume-using-a-flat-panel-detector
#10
Takumi Kuriyama, Nobuyuki Sakai, Mikiya Beppu, Chiaki Sakai, Hirotoshi Imamura, Iwao Kojima, Katsuhiro Masago, Nobuyuki Katakami
Objective Similar to perfusion studies after acute ischemic stroke, measuring cerebral blood volume (CBV) via C-arm computed tomography before and after therapeutic interventions may help gauge subsequent revascularization. We tested serial dilutions of intra-arterial injectable contrast medium (CM) to determine the optimal CM concentration for quantifying parenchymal blood volume by flat-panel detector imaging (FD-PBV). Methods CM was diluted via saline power injector, instituting time delays for FD-PBV studies...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28758524/transit-time-homogenization-in-ischemic-stroke-a-novel-biomarker-of-penumbral-microvascular-failure
#11
Thorbjørn S Engedal, Niels Hjort, Kristina D Hougaard, Claus Z Simonsen, Grethe Andersen, Irene Klærke Mikkelsen, Jens K Boldsen, Simon F Eskildsen, Mikkel B Hansen, Hugo Angleys, Sune N Jespersen, Salvador Pedraza, Tae H Cho, Joaquín Serena, Susanne Siemonsen, Götz Thomalla, Norbert Nighoghossian, Jens Fiehler, Kim Mouridsen, Leif Østergaard
Cerebral ischemia causes widespread capillary no-flow in animal studies. The extent of microvascular impairment in human stroke, however, is unclear. We examined how acute intra-voxel transit time characteristics and subsequent recanalization affect tissue outcome on follow-up MRI in a historic cohort of 126 acute ischemic stroke patients. Based on perfusion-weighted MRI data, we characterized voxel-wise transit times in terms of their mean transit time (MTT), standard deviation (capillary transit time heterogeneity - CTH), and the CTH:MTT ratio (relative transit time heterogeneity), which is expected to remain constant during changes in perfusion pressure in a microvasculature consisting of passive, compliant vessels...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28752790/ph-imaging-reveals-worsened-tissue-acidification-in-diffusion-kurtosis-lesion-than-the-kurtosis-diffusion-lesion-mismatch-in-an-animal-model-of-acute-stroke
#12
Enfeng Wang, Yin Wu, Jerry S Cheung, Iris Yuwen Zhou, Takahiro Igarashi, XiaoAn Zhang, Phillip Zhe Sun
Diffusion weighted imaging (DWI) has been commonly used in acute stroke examination, yet a portion of DWI lesion may be salvageable. Recently, it has been shown that diffusion kurtosis imaging (DKI) defines the most severely damaged DWI lesion that does not renormalize following early reperfusion. We postulated that the diffusion and kurtosis lesion mismatch experience heterogeneous hemodynamic and/or metabolic injury. We investigated tissue perfusion, pH, diffusion, kurtosis and relaxation from regions of the contralateral normal area, diffusion lesion, kurtosis lesion and their mismatch in an animal model of acute stroke...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28751692/ct-perfusion-stroke-imaging-a-threshold-free-probabilistic-approach-to-predict-infarct-volume-compared-to-traditional-ischemic-thresholds
#13
Fabian Flottmann, Gabriel Broocks, Tobias Djamsched Faizy, Marielle Ernst, Nils Daniel Forkert, Malte Grosser, Götz Thomalla, Susanne Siemonsen, Jens Fiehler, André Kemmling
The aim was to evaluate a novel method of threshold-free prediction of brain infarct from computed tomography perfusion (CTP) imaging in comparison to conventional ischemic thresholds. In a multicenter cohort of 161 patients with acute large vessel occlusion who received endovascular therapy, brain infarction was predicted by CTP using (1) optimized parameter cut-off values determined by ROC curve analysis and (2) probabilistic logistic regression threshold-free analysis. Predicted infarct volumes and prediction errors based on four perfusion parameter maps were compared against observed infarcts...
July 27, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28744190/hypoxia-in-cns-pathologies-emerging-role-of-mirna-based-neurotherapeutics-and-yoga-based-alternative-therapies
#14
REVIEW
Gillipsie Minhas, Deepali Mathur, Balakrishnan Ragavendrasamy, Neel K Sharma, Viraaj Paanu, Akshay Anand
Cellular respiration is a vital process for the existence of life. Any condition that results in deprivation of oxygen (also termed as hypoxia) may eventually lead to deleterious effects on the functioning of tissues. Brain being the highest consumer of oxygen is prone to increased risk of hypoxia-induced neurological insults. This in turn has been associated with many diseases of central nervous system (CNS) such as stroke, Alzheimer's, encephalopathy etc. Although several studies have investigated the pathophysiological mechanisms underlying ischemic/hypoxic CNS diseases, the knowledge about protective therapeutic strategies to ameliorate the affected neuronal cells is meager...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28738690/magnetic-resonance-imaging-in-children-presenting-migraine-with-aura-association-of-hypoperfusion-detected-by-arterial-spin-labelling-and-vasospasm-on-mr-angiography-findings
#15
Domitille Cadiot, Romain Longuet, Bertrand Bruneau, Catherine Treguier, Aline Carsin-Vu, Isabelle Corouge, Constantin Gomes, Maïa Proisy
Objective A child presenting with a first attack of migraine with aura usually undergoes magnetic resonance imaging (MRI) to rule out stroke. The purpose of this study was to report vascular and brain perfusion findings in children suffering from migraine with aura on time-of-flight MR angiography (TOF-MRA) and MR perfusion imaging using arterial spin labelling (ASL). Methods We retrospectively included all children who had undergone an emergency MRI examination with ASL and TOF-MRA sequences for acute neurological deficit and were given a final diagnosis of migraine with aura...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28736735/arginine-and-citrulline-for-the-treatment-of-melas-syndrome
#16
Ayman W El-Hattab, Mohammed Almannai, Fernando Scaglia
MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) syndrome is a maternally inherited mitochondrial disease with a broad spectrum of manifestations. In addition to impaired energy production, nitric oxide (NO) deficiency occurs in MELAS syndrome and leads to impaired blood perfusion in microvasculature that can contribute to several complications including stroke-like episodes, myopathy, and lactic acidosis. The supplementation of NO precursors, L-arginine and L-citrulline, increases NO production and hence can potentially have therapeutic utility in MELAS syndrome...
January 2017: Journal of Inborn Errors of Metabolism and Screening
https://www.readbyqxmd.com/read/28733991/ph-sensitive-amide-proton-transfer-effect-dominates-the-magnetization-transfer-asymmetry-contrast-during-acute-ischemia-quantification-of-multipool-contribution-to-in-vivo-cest-mri
#17
Yin Wu, Iris Yuwen Zhou, Dongshuang Lu, Emiri Manderville, Eng H Lo, Hairong Zheng, Phillip Zhe Sun
PURPOSE: To determine the origins of in vivo magnetization transfer asymmetry contrast during acute ischemic stroke, particularly in the diffusion lesion, perfusion lesion, and their mismatch using a middle cerebral artery occlusion rat model of acute stroke. METHODS: Adult male Wistar rats underwent multiparametric MRI of diffusion, perfusion, T1 , and amide proton transfer (APT) imaging at 4.7 T following a middle cerebral artery occlusion procedure. A multipool Lorentzian model, including the nuclear Overhauser effect, magnetization transfer, direct water saturation, amine and amide chemical exchange saturation transfer effects, was applied for Z-spectrum fitting to determine the sources of in vivo magnetization transfer asymmetry following acute stroke...
July 21, 2017: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
https://www.readbyqxmd.com/read/28731381/reperfusion-after-ischemic-stroke-is-associated-with-reduced-brain-edema
#18
Hannah J Irvine, Ann-Christin Ostwaldt, Matthew B Bevers, Simone Dixon, Thomas Wk Battey, Bruce Cv Campbell, Stephen M Davis, Geoffrey A Donnan, Kevin N Sheth, Reza Jahan, Jeffrey L Saver, Chelsea S Kidwell, W Taylor Kimberly
Rapid revascularization is highly effective for acute stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. We investigated the relationship between reperfusion and edema in patients from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE) cohorts. Reperfusion percentage was measured as the difference in perfusion-weighted imaging lesion volume between baseline and follow-up (day 3-5 for EPITHET; day 6-8 for MR RESCUE)...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28730951/penumbra-and-re-canalization-acute-computed-tomography-in-ischemic-stroke-evaluation-practise-study-protocol
#19
Salwa El-Tawil, Joanna Wardlaw, Ian Ford, Grant Mair, Tom Robinson, Lalit Kalra, Keith W Muir
Rationale Multimodal imaging, including computed tomography angiography and computed tomography perfusion imaging, yields additional information on intracranial vessels and brain perfusion and can differentiate between ischemic core and penumbra which may affect patient selection for intravenous thrombolysis. Hypothesis The use of multimodal imaging will increase the number of patients receiving intravenous thrombolysis and lead to better treatment outcomes. Sample size 400 patients. Methods and design PRACTISE is a prospective, multicenter, randomized, controlled trial in which patients presenting within 4...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28727355/-perfusion-imaging-of-acute-ischemic-stroke
#20
Carlo W Cereda, Patrik Michel, Karl-Olof Lovblad, Emmanuel Carrera
Multi-modal imaging in acute ischemic stroke includes structural imaging, perfusion imaging and angiographic assessment of brain arteries. Perfusion imaging discriminates brain tissue that is critically hypo-perfused but salvageable (ischemic penumbra) from irreversibly injured tissue (ischemic core). In acute reperfusion therapies (intravenous or endovascular), patients who have substantial penumbra and a small core (target mismatch pattern) are most likely to have a good clinical outcome. Patient selection based on multi-modal imaging is not proven mandatory for acute treatment in patients admitted within the established time-window...
April 26, 2017: Revue Médicale Suisse
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