Background and Purpose-The etiologic mechanisms of young ischemic stroke in Chinese are largely unknown. This work thus studied the etiologies of young ischemic stroke in Taiwan Chinese and made a comparison with previous reports. Methods-From January 1997 to October 2001, a total of 264 consecutive young ischemic stroke patients (18 to 45 years old) were admitted to the Department of Neurology in our hospital. The risk factors for stroke and the distribution of stroke subtype were studied. The vascular ultrasound and angiographic findings of these patients were also studied. Results-The sample contained 188 men and 76 women. Cerebral infarction was diagnosed in 241 patients and transient ischemic attack in 23 (8.7%). Regarding stroke subtype, stroke of small-vessel occlusion was diagnosed in 20.5% of cases, large-artery atherosclerosis in 7.2%, cardioembolism in 17.8%, other determined etiology in 22.3%, and undetermined etiology in 23.5%. The 4 most common risk factors were hyperlipidemia (53.1%), smoking (49.8%), hypertension (45.8%), and family history of stroke (29.3%). Twenty-three patients (9.6%) had significant stenosis (Ն50%) of the carotid (7.5%) and vertebral arteries (2.1%), the most common cause of which was dissection (60.9%). Forty-five patients (26.5%) had significant intracranial stenosis with 18.8% in the carotid and 10.6% in the vertebrobasilar system, and 5 (2.9%) had stenosis in both systems. Premature atherosclerosis (33.3%) was the most common cause of intracranial stenosis. Conclusions-Our study found that strokes of other determined etiology and undetermined etiology were most common among the sample group, and a battery of extensive examinations is indicated to elucidate the etiology for further stroke prevention. Intracranial stenosis is more common than extracranial stenosis in both the carotid and vertebrobasilar systems.

LOA from posterior dural sac and subjacent lamina is the most valuable finding in the diagnosis of Hirayama disease at neutral-position MR imaging.

MTBI-induced differences in working memory functional activity were observed even though differences in behavioral performance between MTBI patients and controls were absent, which suggests that this approach may increase sensitivity to MTBI compared with neuropsychological evaluation alone.

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.

Background and Purpose-To determine the accuracy of multislice computed tomographic (CT) angiography in diagnosing total versus near occlusions of the internal carotid artery (ICA). Methods-Fifty-seven ICA total or near occlusions identified by catheter angiography were studied with multislice CT angiography 1 to 3 days after catheter angiography. CT angiography in diagnosing total versus near occlusions was analyzed by 2 radiologists independently. The results were compared with those of catheter angiography. Results-Catheter angiography depicted 31 total occlusions, including 10 without a stump, 19 with a stump Ͻ2 cm, and 2 with a stump Ͼ2 cm. Among them, 22 had a downward extent of the retrograde ICA flow at or above the carotid siphon, 8 at the carotid canal, and 1 at the distal cervical ICA. Catheter angiography depicted 26 near occlusions, including 21 with a tight stenosis at the proximal third cervical ICA, 1 at the middle third, and 4 at the carotid canal or siphon. CT angiography correctly depicted all total and near occlusions. In total occlusions, the length of the stump and the retrograde flow were all accurately described by CT angiography. In near occlusions, the sites of tight stenoses were also correctly identified by CT angiography. Conclusions-Multislice CT angiography had an excellent correlation with catheter angiography in diagnosing total versus near occlusion of the ICA. It may be considered as a substitute of catheter angiography in confirming the ultrasonographic results in diagnosing total versus near occlusions of the ICA. Key Words: angiography, computed tomographic Ⅲ carotid arteries Ⅲ carotid stenosis Ⅲ computed tomography A n exact differentiation between total and near occlusions of the internal carotid artery (ICA) is important for the therapeutic approach. Patients with occlusive lesions are usually treated medically, whereas patients with near occlusions may benefit from surgery. In the initial workup, these patients are usually examined by color-coded carotid duplex ultrasonography (US). A sensitivity of 86% to 94% for near occlusions and 100% for total occlusions has been reported. 1 In respect of magnetic resonance (MR) angiographic techniques, gadoliniumenhanced 3-dimensional MR angiography was found to be the best MR technique, with a sensitivity of 100% for near occlusions and 100% for total occlusions. 2 With regard to CT angiography, a review of the literature did not reveal any CT angiographic study focusing on the subject. The aim of this study was to evaluate the accuracy of the multislice CT angiography in diagnosing total versus near occlusions of the ICA. Subjects and Methods PatientsBetween July 2000 and February 2003, 512 patients with clinical suspicion of ischemic stroke were selected for catheter angiography.A total of 276 of these who had ICA diameter stenosis Ͼ60% were selected as potential candidates for multislice CT angiography on the next 1 to 3 days after catheter angiography. Patients were excluded if they declined to enter this study (nϭ6) or did no...

CT grading of BPIs was useful in predicting ductal integrity or disruption. Ductal disruption was likely present if the pancreas appeared to have a transection or deep laceration on CT scans. It was accurate in grade A and B injuries. Overestimation could occur in grade CI and CII injuries.

Hirayama disease is so rare that it is easily misdiagnosed. Diagnosis is achieved via clinical presentation, neurophysiological examination, and neuroradiological imaging studies (dynamic MR imaging). The anterior decompressive approach may be better for patients showing anterior effacement and severe cervical kyphosis during neck flexion in MR imaging.

BackgroundThis study uses a MRI technique, three-dimension pulse continuous arterial spin labeling (3D-PCASL), to measure the patient’s cerebral blood flow (CBF) at the subacute stage of mild traumatic brain injury (MTBI) in order to analyze the relationship between cerebral blood flow and neurocognitive deficits.ObjectiveTo provide the relationship between cortical CBF and neuropsychological dysfunction for the subacute MTBI patients.MethodsAfter MTBI, perfusion MR imaging technique (3D-PCASL) measures the CBF of MTBI patients (n = 23) within 1 month and that of normal controls (n = 22) to determine the quantity and location of perfusion defect. The correlation between CBF abnormalities and cognitive deficits was elucidated by combining the results of the neuropsychological tests of the patients.ResultWe observed a substantial reduction in CBF in the bilateral frontal and left occipital cortex as compared with the normal persons. In addition, there were correlation between post concussive symptoms (including dizziness and simulator sickness) and CBF in the hypoperfused areas. The more severe symptom was correlated with higher CBF in bilateral frontal and left occipital lobes.ConclusionFirst, this study determined that despite no significant abnormality detected on conventional CT and MRI studies, hypoperfusion was observed in MTBI group using 3D-PCASL technique in subacute stage, which suggested that this approach may increase sensitivity to MTBI. Second, the correlation between CBF and the severity of post concussive symptoms suggested that changes in cerebral hemodynamics may play a role in pathophysiology underlies the symptoms.