Inflammation has been implicated as a secondary injury mechanism following ischemia and stroke. A variety of experimental models, including thromboembolic stroke, focal and global ischemia, have been used to evaluate the importance of inflammation. The vasculature endothelium promotes inflammation through the upregulation of adhesion molecules such as ICAM, E-selectin, and P-selectin that bind to circulating leukocytes and facilitate their migration into the CNS. Once in the CNS, the production of cytotoxic molecules may facilitate cell death. The macrophage and microglial response to injury may either be beneficial by scavenging necrotic debris or detrimental by facilitating cell death in neurons that would otherwise recover. While many studies have tested these hypotheses, the importance of inflammation in these models is inconclusive. This review summarizes data regarding the role of the vasculature, leukocytes, blood-brain barrier, macrophages, and microglia after experimental and clinical stroke.
Sixty-four-section multidetector CT trajectography facilitates the identification of transdiaphragmatic trajectory, which accurately rules in PDI when identified. Contiguous injury remains a highly sensitive sign, even when patients with multiple injuries are considered, and is useful for excluding PDI.
Introduction
Empty sella in MRI is an important finding associated with idiopathic intracranial hypertension (IIH). This study assesses the sensitivity and reproducibility of several morphological measures of the sella and pituitary gland to indentify the measure that best differentiates IIH from controls. Additionally, the study assesses reversal in gland compression following treatment.
Methods
Sagittal 3D-T1W sequence with 1 mm isotropic resolution was obtained from ten newly diagnosed IIH patients and 11 matched healthy controls. Follow-up MRI scans were obtained from eight patients at 1-week postlumbar puncture and acetazolamide treatment. 1D and 2D measures of absolute and normalized heights and crosssectional areas of the gland and sella were obtained to identify the measure that best differentiates IIH patients and controls.
Results
Overall area-based measurements had higher sensitivity than length with p<0.0001 for sella area compared with p=0.004 for normalized gland height. The gland crosssectional areas were similar in both cohorts (p=0.557), while the sella area was significantly larger in IIH, 200±24 versus 124±25 mm2, with the highest sensitivity and specificity, 100 % and 90.9 %, respectively. Absolute gland area was the most sensitive measure for assessing post treatment changes, with 100 % sensitivity and 50 % specificity. Average posttreatment gland area was 18 % larger (p=0.016). Yet, all eight patients remained within the empty sella range based on a normalized gland area threshold of 0.41.
Conclusions
Sellar area is larger in IIH, and it demonstrated highest sensitivity for differentiating IIH from control subjects, while absolute gland area was more sensitive for detecting post treatment changes.
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