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Therapeutic hypothermia (TH) benefits survivors of cardiac arrest and neonatal hypoxic–ischemic injury and may benefit stroke patients. Large TH clinical trials, however, have shown mixed results. Given the substantial pre-clinical literature supporting TH, we explored possible mechanisms for clinical trial variability. Using a standard rodent stroke model ( n = 20 per group), we found smaller infarctions after 2 h pre- or post-reperfusion TH compared to 4 h. To explore the mechanism of this discrepancy, we used primary cell cultures of rodent neurons, astrocytes, or endothelial cells subjected to oxygen–glucose deprivation (OGD). Then, cells were randomly assigned to 33℃, 35℃ or 37℃ for varying durations after varying delay times. Both 33 and 35℃ TH effectively preserved all cell types, although 33℃ was superior. Longer cooling durations overcame moderate delays to cooling initiation. In contrast, TH interfered with astrocyte paracrine protection of neurons in a temperature-dependent manner. These findings suggest that longer TH is needed to overcome delays to TH onset, but shorter TH durations may be superior to longer, perhaps due to suppression of astrocytic paracrine support of neurons during injury. We propose a scheme for optimizing TH after cerebral injury to stimulate further studies of cardiac arrest and stroke.

Among patients with myelopathy, spinal angiography is mandatory in the presence of both T2 hyperintensity and flow voids but may be unnecessary if both of these findings are absent.

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Non-traumatic intracranial hemorrhage includes subarachnoid hemorrhage, subdural hemorrhage, and intracerebral hemorrhage (ICH), which can be classified as primary or secondary. Primary ICH is due to arterial hypertension or cerebral amyloid angiopathy, and secondary ICH is due to cerebral vascular malformations, coagulopathies, infectious complications, brain tumors, and illicit stimulant drug use. This review explores the epidemiology and management of non-traumatic ICH in women, with a focus on pregnancy and the post-partum period, defined as 6 weeks post-delivery.

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Patients with amyotrophic lateral sclerosis (ALS) are often told that solid organ donation is not possible following death, although the reasons for exclusion are not evidence based. Because ALS patients typically remain sentient until death, organs may be procured under donation after cardiac death protocols. Anticipating this need, our institution created a process for organ donation in ventilator-dependent ALS patients that was subsequently implemented. To our knowledge, this is the first report of organ donation in a patient with rapidly progressive ventilator-dependent ALS.

Background Few studies directed at assessing the visualization of the walls of unruptured aneurysms have used higher‐resolution 3D MRI vessel wall imaging. Prospective longitudinal studies are also needed to screen vessel wall changes in unruptured aneurysms. Purpose To compare the aneurysm wall visualization on pre‐ and post‐3D isotropic T1‐weighted Sampling Perfection with Application‐optimized Contrasts by using different flip angle Evolutions (SPACE) images and to explore whether there is a change in wall enhancement at follow up. Study Type Prospective. Population Twenty‐nine patients with a total of 35 unruptured intracranial aneurysms. Sequence 3D T1‐weighted pre‐ and postcontrast SPACE (0.5 mm isotropic) at 3.0T. Assessment The aneurysm wall visibility (0–5 scale) between pre‐ and postcontrast images as well as the wall enhancement (0–5 scale) between follow‐up and baseline studies (6–30 months, average 12.7 months) were compared. Differences in wall visibility and enhancement were also investigated as a function of aneurysm diameter and location. Statistical Test The Wilcoxon signed rank paired test was used to compare the wall visibility score between pre‐ and postcontrast SPACE images, as well as wall enhancement between follow‐up and baseline. The Mann–Whitney and Kruskal–Wallis tests were used to investigate the enhancement difference between different diameters and locations. Results Postcontrast images had significantly higher wall visibility (P = 0.01). A wall enhancement score ≥2 was found in 71% of the aneurysms. Changes in levels of wall enhancement were found in 17% of the aneurysms at follow‐up studies, but those changes were small. Wall visibility and enhancement scores of large aneurysms were significantly higher than small ones (P < 0.001). Data Conclusion 3D T1‐weighted higher resolution SPACE can be used to assess changes in enhancement at follow‐up studies. Contrast SPACE image provides better aneurysm wall visibility and improves visualization of the aneurysm wall. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:193–200.