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Bilateral Medial Medullary Infarction with Nondominant Vertebral Artery Occlusion
Bilateral medial medullary infarction (MMI) is a rare stroke subtype. Here, we report a case with bilateral MMI caused by nondominant vertebral artery occlusion confirmed by brain digital subtraction angiography and magnetic resonance imaging basi-parallel-anatomical-scanning. We highlight that anterior spinal arteries could originate from a unilateral vertebral artery (VA). Radiologists and neurologists should pay attention to the nondominant VA as bilateral MMI may be induced by occlusion of nondominant VA that supplies the bilateral anteromedial territories of the medulla.
Source: Journal of Stroke and Cerebrovascular Diseases - July 11, 2015 Category: Neurology Authors: Lei Zhang, Gui-lian Zhang, Ju-mei Du, Zhu-lin Ma Tags: Case Report Source Type: research

Limited versus Whole-Brain Perfusion for the Indication of Thrombolysis in the Extended Time Window of Acute Cerebral Ischemia
Perfusion computed tomography (PCT) has emerged as alternative to magnetic resonance imaging (MRI) for assessment of patients clinically qualifying for off-label thrombolysis within 4.5 to 9 hours after onset of ischemic stroke. However, disadvantage of PCT is its often limited anatomic coverage with only 2 or 3 slices when using a 4- to 64-section scanner. Our purpose was therefore to evaluate the value of 2- and 3-slice perfusion compared to whole-brain perfusion.
Source: Journal of Stroke and Cerebrovascular Diseases - September 12, 2015 Category: Neurology Authors: Lorenz Breuer, Michael Knott, Tobias Struffert, Stephan Kloska, Natalia Kurka, Stefan Schwab, Arnd Dörfler, Martin Köhrmann, Tobias Engelhorn Source Type: research

Gas Embolic Stroke Secondary to Bowel Infarction
A 69-year-old gentleman with metastatic esophageal adenocarcinoma presented with acute abdominal pain to the emergency medicine department and subsequently developed an acute left hemiplegia while in the resuscitation unit. An unenhanced computed tomography (CT) scan of the head showed right frontal cerebral gas emboli while an unenhanced CT scan of the abdomen and pelvis showed extensive portal venous gas and pneumatosis intestinalis, presumed secondary to bowel infarction.
Source: Journal of Stroke and Cerebrovascular Diseases - November 16, 2015 Category: Neurology Authors: Dhruv Parikh, Joe Joseph Leyon, Swarupsinh Chavda Tags: Case Studies Source Type: research

Cerebral Air Embolism with Pneumomediastinum Resulting from Emesis: A Case Report
Cerebral air embolism (CAE) is a rare cause of stroke. Most cerebral air emboli are caused by iatrogenic factors, such as invasive cardiac and pulmonary procedures. Here, we report an unusual case of CAE not related to any medical intervention. An 87-year-old woman became unresponsive after vomiting. A computed tomography (CT) scan of the head 6 hours after the onset of the vomiting revealed multiple air emboli, mainly in the watershed area between the right anterior and middle cerebral arteries.
Source: Journal of Stroke and Cerebrovascular Diseases - August 7, 2016 Category: Neurology Authors: Hiromitsu Tabata, Hiroshi Kitaguchi, Yuki Terajima, Katsuro Shindo Tags: Case Studies Source Type: research

Improving Prognostic Evaluation by 4D CTA for Endovascular Treatment in Acute Ischemic Stroke Patients: A Preliminary Study
Objective: We aim to use 4D CTA with a comprehensive and objective scoring system to assess collateral circulation, and explore the value of prognosis prediction in endovascular treated patients. Methods: Thirty-four patients with unilateral anterior circulation large vessels occlusion were reviewed in this study retrospectively. Single-phase CTA (sCTA) and 4D CTA acquired by CT perfusion scanning were analyzed for collateral circulation assessment. The collateral vessels were scored 0-4 according to modified collateral circulation scoring based on 4D CTA.
Source: Journal of Stroke and Cerebrovascular Diseases - April 9, 2019 Category: Neurology Authors: Ruoyao Cao, Peng Qi, Yinhong Liu, Xinxin Ma, Zhengyin Shen, Juan Chen Source Type: research

White Matter Lesion Severity is Associated with Intraventricular Hemorrhage in Spontaneous Intracerebral Hemorrhage
Background: Intraventricular hemorrhage (IVH) and white matter lesion (WML) severity are associated with higher rates of death and disability in intracerebral hemorrhage (ICH). A prior report identified an increased risk of IVH with greater WML burden but did not control for location of ICH. We sought to determine whether a higher degree of WML is associated with a higher risk of IVH after controlling for ICH location. Methods: Utilizing the patient population from 2 large ICH studies; the Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) Study and the Ethnic/Racial Variations of Intracerebral Hemo...
Source: Journal of Stroke and Cerebrovascular Diseases - February 27, 2020 Category: Neurology Authors: Vaibhav Vagal, Simone U. Venema, Tyler P. Behymer, Eva A. Mistry, Padmini Sekar, Russell P. Sawyer, Lee Gilkerson, Charles J. Moomaw, Mary Haverbusch, Elisheva R. Coleman, Matthew L. Flaherty, Carson Van Sanford, Robert J. Stanton, Christopher Anderson, J Source Type: research

Rules About Rules – The 6-h CT Rule For Subarachnoid Hemorrhage
In this issue of the Journal of Stroke and Cerebrovascular Diseases, Chakraborty and colleagues describe the cautionary tale of a patient who presented with a thunderclap headache concerning for a subarachnoid hemorrhage (SAH). A head computed tomographic scan (CT) done 4  h after the onset of the headache was interpreted as negative but the patient was ultimately found to have an aneurysmal SAH.1
Source: Journal of Stroke and Cerebrovascular Diseases - September 15, 2020 Category: Neurology Authors: Jonathan A. Edlow Source Type: research

Preoperatively estimated graft flow rate contributes to the improvement of hemodynamics in revascularization for Moyamoya disease
Moyamoya disease is a cerebrovascular disease that is characterized by chronic progressive stenosis of the terminal portion of the internal carotid artery (ICA) on both sides of the brain, which results in an abnormal vascular network of the collateral pathways at the base of the brain.1,2 Therefore, patients with Moyamoya disease have a decreased cerebral blood flow (CBF) and reduced cerebral perfusion pressure,3 which can result in ischemic and/or hemorrhagic stroke. This hemodynamic condition can be evaluated using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) as the gold standard procedure.
Source: Journal of Stroke and Cerebrovascular Diseases - November 7, 2020 Category: Neurology Authors: Tomoyoshi Kuribara, Takeshi Mikami, Katsuya Komatsu, Yusuke Kimura, Sangnyon Kim, Kei Miyata, Yukinori Akiyama, Rei Enatsu, Toru Hirano, Nobuhiro Mikuni Source Type: research

Volumetric White Matter Hyperintensity Ranges Correspond to Fazekas Scores on Brain MRI
Leukoaraiosis presents as white matter hyperintensities (WMH) on magnetic resonance (MR) imaging. It is thought to originate from decreased vascular supply to axons with an accompanying loss of axonal integrity. WMH have been found to be more prevalent in older patients, especially in those with neurodegeneration from Alzheimer's disease (AD) or stroke.1-6A visual categorization method named the Fazekas scale was developed in order to compare white matter disease burden on computed tomography scans between patients experiencing normal aging and those with AD.
Source: Journal of Stroke and Cerebrovascular Diseases - February 11, 2022 Category: Neurology Authors: Ariana Andere, Gaurav Jindal, Janine Molino, Scott Collins, Derek Merck, Tina Burton, Christoph Stretz, Shadi Yaghi, Daniel C. Sacchetti, Sleiman El Jamal, Michael E. Reznik, Karen Furie, Shawna Cutting Tags: Short Communication Source Type: research

Correlation Between Severity of Carotid Stenosis and Vascular Reserve Measured by Acetazolamide Brain Perfusion Single Photon Emission Computed Tomography
This study examined that relationship. A total of 56 ICAs in 43 patients were included. Computed tomography scan or magnetic resonance imaging showed no evidence of infarction in any of these patients. Both iodine-123-N-isopropyl-p-iodoamphetamine (123IMP)–single photon emission computed tomography (SPECT) in the resting state and 123IMP-SPECT with acetazolamide (ACZ) enhancement were performed. Quantitated cerebral blood flow (CBF) images were acquired with the 123IMP autoradiography technique. The mean CBF without ACZ administration (resting CBF) and CVR in the middle cerebral artery territory were calculated using ste...
Source: Journal of Stroke and Cerebrovascular Diseases - September 9, 2011 Category: Neurology Authors: Noriaki Tomura, Takahiro Otani, Makoto Koga, Koichi Ishiyama Tags: Original Articles Source Type: research

Assessment of Moyamoya Disease Using Multidetector Row Computed Tomography
The recent introduction of multidetector row computed tomography (MDCT) scanners has enabled high-resolution 3-dimensional reconstruction. The purpose of this study was to establish a method to evaluate moyamoya disease using computed tomography angiography (CTA), specifically MDCT. Twenty-four patients (48 sides total) with moyamoya disease diagnosed by magnetic resonance angiography (MRA) were evaluated by means of CTA using MDCT by 3 independent observers, and the resulting 144 sides were analyzed. CTA and MRA were compared in terms of the steno-occlusive changes exhibited in each vessel. CTA and MRA scores were assigne...
Source: Journal of Stroke and Cerebrovascular Diseases - February 24, 2012 Category: Neurology Authors: Toshiya Sugino, Takeshi Mikami, Shunya Ohtaki, Tohru Hirano, Satoshi Iihoshi, Kiyohiro Houkin, Nobuhiro Mikuni Tags: Original Articles Source Type: research

Hippocampal Magnetic Resonance Imaging Abnormalities in Cardiac Arrest are Associated with Poor Outcome
Conclusions: Bilateral hippocampal hyperintensities on MRI may be a specific imaging finding that is indicative of poor prognosis in patients who suffer global hypoxic–ischemic injury. More research on the prognostic significance of this and similar neuroimaging patterns is indicated.
Source: Journal of Stroke and Cerebrovascular Diseases - September 20, 2012 Category: Neurology Authors: David M. Greer, Patricia D. Scripko, Ona Wu, Brian L. Edlow, James Bartscher, Jonathan R. Sims, Erica E.C. Camargo, Aneesh B. Singhal, Karen L. Furie Tags: Original Articles Source Type: research

Leukoaraiosis is Associated with Short- and Long-term Mortality in Patients with Intracerebral Hemorrhage
Conclusions: In unselected patients in Southern Norway with first-ever ICH, severe leukoaraiosis is independently associated with both 30-day and long-term mortality in 30-day survivors. Warfarin is independently associated with 30-day mortality and coronary heart disease with long-term mortality in 30-day survivors. Recurrent ICH is more frequent after lobar ICH than after ICH in other locations.
Source: Journal of Stroke and Cerebrovascular Diseases - February 25, 2013 Category: Neurology Authors: Arnstein Tveiten, Unn Ljøstad, Åse Mygland, Halvor Naess Tags: Original Articles Source Type: research

Eight and a Half Syndrome with Hemiparesis and Hemihypesthesia: The Nine Syndrome?
We report a 71-year-old man who presented with eight and a half syndrome associated with contralateral hemiparesis and hemihypesthesia, in which brain magnetic resonance imaging scans revealed a lacunar pontine infarction also involving the corticospinal tract and medial lemniscus. These features could widen the spectrum of pontine infarctions, configuring a possible “nine” syndrome.
Source: Journal of Stroke and Cerebrovascular Diseases - February 22, 2013 Category: Neurology Authors: Francesca Rosini, Elena Pretegiani, Francesca Guideri, Alfonso Cerase, Alessandra Rufa Tags: Case Reports Source Type: research

Cerebral Infarction in an HIV-Infected Patient with Combined Protein S and C Deficiency and a Patent Foramen Ovale
A 41-year-old male with a history of human immunodeficiency virus (HIV) infection developed motor aphasia, dysarthria, and right hemiparesis. A magnetic resonance imaging scan of the brain revealed a cerebral infarction in the territory of the left middle cerebral artery. The laboratory data showed decreased levels of protein S and protein C. Transesophageal contrast-enhanced echocardiography revealed a patent foramen ovale (PFO). Prothrombotic states, such as protein S and C deficiency, have been reported in HIV-infected patients. In addition, previous studies have reported prothrombotic states to be risk factors for PFO-...
Source: Journal of Stroke and Cerebrovascular Diseases - May 13, 2013 Category: Neurology Authors: Ran Tomomasa, Kazuo Yamashiro, Ryota Tanaka, Nobutaka Hattori Tags: Case Reports Source Type: research

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