Stroke Magnetic Resonance Imaging Is Accurate in Hyperacute Intracerebral Hemorrhage

Fiebach, Jochen B.; Schellinger, Peter D.; Gass, Achim; Kucinski, Thomas; Siebler, Mario; Villringer, Arno; Ölkers, Peter; Hirsch, Jochen G.; Heiland, Sabine; Wilde, P.; Jansen, Olav; Röther, Joachim; Hacke, Werner; Sartor, Klaus

doi:10.1161/01.str.0000114203.75678.88

Cited by 380 publications

(174 citation statements)

References 24 publications

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“…PWI and DWI allow actual ischemic lesions to be delineated with a relatively high sensitivity and specificity (1)(2)(3)(4)(5)(6)(7). In acute ischemic brain tissue DWI can detect decreased movement of water protons due to cytotoxic edema, which results in a decrease of the apparent diffusion coefficient (ADC) of water and an increase in the signal intensity.…”

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confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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Purpose: To determine whether the perfusion deficit could predict brain infarction in patients with chronic cerebral ischemia who experienced recurring episodes of neurological symptoms and showed a perfusion-diffusion mismatch on magnetic resonance (MR) images. Materials and Methods:In 53 consecutive patients (38 males and 15 females, 62 Ϯ 13 years old) with ischemia in the middle cerebral artery (MCA) territory, lesion volumetry was performed on parametric maps of the time-to-peak, the cerebral blood volume, and diffusion-weighted (DW) images. The infarct lesions were assessed on follow-up T2-weighted (T2W) MR images after eight days. Cerebrovascular changes were determined by time-of-flight (TOF) MR angiography (MRA). Inferential and correlation statistics were used. Results:Patients with chronic ischemic brain disease (N ϭ 39) who presented with a severe perfusion-diffusion mismatch in the presence of a normal cerebral blood volume had no or small brain infarctions as found on follow-up T2W images. MRA revealed widespread abnormalities of the basal cerebral arteries compatible with brain perfusion abnormalities. In contrast, in acute stroke patients (N ϭ 14) the deficit of cerebral perfusion predicted the infarct lesion in the T2W images. Conclusion:Our results suggest that in chronic cerebral ischemia the normal blood volume was maintained despite the depression of cerebral perfusion and recurring minor insults.

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confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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“…Diffusion-weighted MR imaging usually shows brain abscesses as hyperintense, whereas brain tumors appear as hypointense. 5,10,12) However, diffusion-weighted MR imaging may show certain stages of hemorrhage as hyperintense, 6) so special attention should be paid to the diagnosis of cystic lesions in the presence of hemorrhage, as hyperintensity would not necessarily indicate brain abscess. tumors, especially gliomas, by MR spectroscopy, 14) although it was not obtained in our case.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging of Brain Abscess With Hemorrhage: Implications for the Mechanism of Hemorrhage -Case Report-

Terakawa

Takami

Yamagata

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 68-year-old woman presented with an extremely rare brain abscess associated with old and acute hemorrhages manifesting as gradual onset of symptoms of headache and fever. Magnetic resonance imaging clearly visualized the hemorrhage as heterogeneously hyperintense on diffusion-weighted imaging, concentric hypo-isointense on T 1 -weighted imaging, and homogeneously hyperintense with a hypointense rim on T 2 *-weighted imaging. T 1 -weighted imaging with contrast medium revealed a wellenhanced cyst wall. In spite of treatment with antibiotics, the neurological status of the patient deteriorated due to expansion of the abscess and perifocal edema. Needle aspiration of the cyst yielded bloody purulent fluid. The magnetic resonance imaging findings indicate that neovascularization of the cyst wall is involved in the mechanism of hemorrhage in brain abscess. Careful follow-up examinations are recommended in patients with brain abscess to detect warning signs of neurological deterioration.

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“…MRI is particularly useful in posterior circulation strokes, lacunar infarctions, small cortical infarcts and, above all, in unusual images when there are doubts as to the diagnosis of stroke. Gradient echo-sequences allow exclusion of hemorrhage with sensitivity and specificity of 100% 98 . Thrombolytic initiation must not be delayed to carry out MRI 99,100 .…”

Section: Imaging In Acute Strokementioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part I

Oliveira‐Filho

Martins

Pontes-Neto

et al. 2012

Arq. Neuro-Psiquiatr.

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These guidelines are a result of several meetings from the Brazilian Stroke Society (Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV, website www.sbdcv.org.br), which represents the Scientific Department in cerebrovascular diseases of the Brazilian Academy of Neurology, responsible for technical opinions and educational projects related to cerebrovascular diseases. Members from SBDCV participated in web-based discussion forum with pre-defined themes, followed by a formal onsite meeting in which controversies and final position statements were discussed. Finally, a writing group was created to revise and translate the final document, which was approved by all members of the SBDCV. The final text aims to guide specialists and non-specialists in stroke care in managing patients with acute ischemic stroke. The hemorrhagic stroke guideline has been previously published by the same group 1 . In the final recommendations, Oxford classification for evidence level and recommendation grade was used: EVIDENCE LEVELS1. Randomized controlled clinical trial (RCT) or systematic review (SR) of RCT with clinical endpoints. 2. RCT or SR of lower quality: with substitute, validated endpoints; with subgroup analysis or with a posteriori hypotheses; with clinical endpoints, but with methodological flaws.3. RCT with substitute, non-validated endpoints case-control studies. 4. Study with clinical endpoint, but with a higher potential bias (as in experiment without comparison group and other observational studies). 5. Representative forum or expert opinion without abovementioned evidence. RECOMMENDATION GRADESA Systematic review (homogeneous) of RCT; or single RCT with narrow confidence interval; or therapeutic results of "all or nothing" type. B Systematic review (homogeneous) of cohort studies; or cohort study and RCT of lower quality; or outcomes research or ecological study; or systematic review (homogeneous) of case-control studies; or case-control study. C Case reports (including cohort or case-control study of lower quality). D Expert opinion without critical evaluation, based on physiological or animal studies.In this first part of the guidelines, specific topics included were: epidemiology, stroke as a medical emergency, education, pre-hospital management, emergency management, neuroimaging and laboratory evaluation. A translated version of these guidelines in Portuguese is available in the Society's webpage (www.sbdcv.org.br).

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Stroke Magnetic Resonance Imaging Is Accurate in Hyperacute Intracerebral Hemorrhage

Cited by 380 publications

References 24 publications

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Magnetic Resonance Imaging of Brain Abscess With Hemorrhage: Implications for the Mechanism of Hemorrhage -Case Report-

Guidelines for acute ischemic stroke treatment: part I

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