Patients may present to the hospital at various times after an ischemic stroke. Many present weeks after a neurologic deficit has occurred, as is often the case with elderly patients and those in a nursing home. The ability to determine the age of an ischemic stroke provides useful clinical information for the patient, his or her family, and the medical team. Many times, perfusion imaging is not performed, and pulse sequence-specific magnetic resonance (MR) imaging findings may help determine the age of the infarct. The findings seen at apparent diffusion coefficient mapping and diffusion-weighted, fluid-attenuated inversion recovery (FLAIR) and unenhanced and contrast material-enhanced T1- and T2-weighted gradient-echo and susceptibility-weighted MR imaging may help determine the relative age of a cerebral infarct. Strokes may be classified and dated as early hyperacute, late hyperacute, acute, subacute, or chronic. Recent data indicate that in many patients with restricted diffusion and no change on FLAIR images, it is more likely than was initially thought that the stroke is less than 6 hours old. The time window to administer intravenous tissue plasminogen activator is currently 4.5 hours from the time when the patient was last seen to be normal, and for anterior circulation strokes, the time window for administering intraarterial tissue plasminogen activator is 6 hours from when the patient was last seen to be normal. For this reason, accurate dating is important in patients with ischemic stroke.

BACKGROUND AND PURPOSE:Cerebral mycotic aneurysms are a rare and deadly type of aneurysm that have no definitive treatment guidelines. Our purpose was to retrospectively review known or suspected cases of CMA in order to identify patient populations that may be associated with higher morbidity and mortality. We hope that the identification of patients with these risk factors will lead to early stratification upon presentation, and more urgent treatment of their CMAs. We also hoped to identify any benefit or complication that was specific to either the endovascular or neurosurgical repair of CMAs.

Neonatal compartment syndrome (NCS) is a rare condition that is often initially misdiagnosed because its skin lesions mimic several other more common diseases of the newborn. It has not been described in the pediatric literature thus far. Early diagnosis along with fasciotomy may be limb and function-sparing, but only in certain cases, because the exact time and duration of the initial insult and the full extent of damage at presentation is unknown in many cases. We present a case of NCS that was initially thought to be amniotic band syndrome, and delayed fasciotomy and debridement were performed once the correct diagnosis was made. We review the literature of this rare and debilitating condition and emphasize the importance of early diagnosis and intervention.

A 47-year-old woman with athetoid cerebral palsy (ACP) experienced isolated right-sided spasticity. Imaging revealed cord edema, a herniated disc, and anterolisthesis (figure, A, B, D). The patient underwent discectomy with spinal fusion (figure, F), and reported improved activities of daily living. Cervical spine pathology is a well-known complication of ACP caused by repetitive head movements which accelerate degenerative joint disease (DJD), but is often overlooked. It may occur in any movement disorder with repetitive head movements. It includes disc degeneration, predominantly at C5/C6 (a common site in DJD), and listhetic instability. 1,2 Suspicion for this pathology in patients with ACP may prevent permanent neurologic deficits.

Primary lung cancer rarely presents with pneumothorax, and when it does one needs to consider endobronchial obstruction as a possible etiology. We present the case of a 31-year-old woman who was diagnosed with asthma within the past 2 years and was recently treated for pneumonia. She presented with persistent massive hydropneumothorax. She had concurrent endobronchial obstruction secondary to adenoid cystic carcinoma. Her pneumothorax decreased with relief of her endobronchial obstruction after interventional bronchoscopy. This case report discusses different types of pneumothoraces and emphasizes that some types are not relieved by chest tube placement, but by relief of endobronchial obstruction. Also emphasized are radiographic findings suggestive of endobronchial obstruction, which should be suspected in an adult with new onset of wheezing with no risk factors and no earlier diagnosis of asthma; this obstruction may be cancerous.