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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 64-year-old right hemiplegic woman, who had been treated for hypertension for 15 years, was admitted to our hospital. Neurologic examination on admission disclosed right hemiplegia and motor aphasia; however, ophthalmoparesis, pupillary abnormality, and blepharoptosis were not evident. Excessive sweating on the right side of the body, which was most marked on the face, was observed. Amount of sweating on the left side of the body was normal. Unilateral hyperhidrosis persisted for more than 2 months. MRI revealed hemorrhagic infarctions in the left basal ganglia, internal capsule, thalamus, hypothalamus, and medial part of the cerebral peduncle. 123I-IMP SPECT disclosed hypoperfusion in the left striatum, thalamus, occipital cortex, and right cerebellar hemisphere. Cerebral angiography revealed arteriosclerotic changes in the basilar artery, but that the left posterior cerebral artery and its branches were not occluded. Unilateral persistent hyperhidrosis is rare after ischemic stroke. Hypothalamic lesion was thought to be responsible for the hyperhidrosis in this patient. As the hypothalamus receives its blood supply from the posterior cerebral artery, unilateral persistent hyperhidrosis may be an important sign of cerebral infarction in the posterior cerebral artery region.
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PMID:[Unilateral persistent hyperhidrosis after ischemic stroke]. 139 37

We performed 123I-IMP single photon emission computed tomography (SPECT) in 43 patients who had a small infarction (less than 2 cm) in subcortical area and who were less than 1 month after onset of stroke. Hypoperfused area of brain was qualitatively assessed and was compared with functional outcome at 6-month after the stroke and the cerebral angiogram. Functional outcome was poorer in patients who had wider hypoperfused area in brain (chi 2 = 29.3; p less than 0.001). The extent of brain hypoperfused area showed a positive correlation with the degree of stenosis in the extracranial and/or intracranial arteries (r = 0.61; p less than 0.01). In patients who had no angiographic abnormality, the extent and the location of the hypoperfused area were equivalent to that of the low density area in CT. Thus 123I-IMP SPECT in patients with a small infarction may discriminate lacunar infarction from embolic or hemodynamic infarction, which was caused by vascular lesions of major cerebral arteries, in subcortical area. Our study suggests that functional outcome is better in lacunar infarction than embolic or hemodynamic infarction in subcortical area.
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PMID:[Relationship between extent of brain hypoperfused area and functional outcome in patients with a small subcortical infarction: evaluation with X-ray CT, 123I-IMP cerebral perfusion SPECT and cerebral angiography]. 157 14

Twenty-eight patients with cerebral infarction were examined by brain SPECT with I-123 IMP a total of 46 times from Day 2 to Day 84 after the onset of stroke. Depending on the pattern of change in the abnormal accumulation of I-123 IMP between the early and delayed images, the patients were classified into one of five types. The number of patients in each type and the number of days after infarction at which each type occurred were as follows: Type (I), n = 5 and 4 +/- 2 days; Type (II), n = 8 and 12 +/- 4 days; Type (III), n = 17 and 21 +/- 11 days; Type (IV), n = 13 and 38 +/- 18 days; and Type (V), n = 3 and 60 +/- 16 days. In 12 patients, 30 brain SPECT were performed that showed the chronological evolution of infarction in sequence from Types (I) to (IV). Hyperactivity in the early image was seen in Type (I) with a subsequent image defect, while in Type (II) there was persistent hyperactivity. Hypoactivity in the early image was seen in Types (III), (IV), and (V), and the activity in the delayed image gradually decreased as the process of infarction terminated. The early image reflected the distribution of lipophilic I-123 IMP, indicating regional cerebral blood flow, while the delayed image showed the distribution of hydrophilic I-123 IMP metabolites superimposed on that of lipophilic I-123 IMP which had accumulated in the brain at the first extraction. Combining the early and delayed images of I-123 IMP brain SPECT may help to understand the evolution of cerebral infarction.
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PMID:Change of accumulation and filling pattern in evolution of cerebral infarction with I-123 IMP brain SPECT. 202 59

To compare the merits of 123I-isopropyl-iodoamphetamine (123I-IMP) and 99mTc-HMPAO in showing abnormal brain uptake distribution during cerebral ischemia, we studied ten patients during the subacute phase of their stroke, a period where metabolism and blood flow are frequently uncoupled. SPECT imaging was performed using both radiopharmaceuticals in the 10 patients from 48 h to 4 weeks after onset of symptoms. Two patients out of the 10 had similar defects with 123I-IMP and 99mTc-HMPAO SPECT, the location of the defects corresponding to the area of infarction observed on CT. Six patients had normal 99mTc-HMPAO SPECT and abnormal 123I-IMP SPECT with defects in the area of infarction shown by CT. The remaining 2 patients had hyperactive abnormalities on 99mTc-HMPAO in areas corresponding to defects on the 123I-IMP images. Two of the patients with SPECT mismatches were studied again more than 1 month after onset. On reexamination, 99mTc-HMPAO SPECT which was previously normal or hyperactive became hypoactive with a focal area of decreased activity corresponding to the defect on 123I-IMP. Crossed cerebellar diaschisis was found in 7 patients with 99mTc-HMPAO and was absent for both 123I-IMP and 99mTc-HMPAO in 3. We suggest that SPECT with 99mTc-HMPAO could show transient hyperemia not demonstrated by 123I-IMP whereas in some cases cerebral infarction would be more difficult to demonstrate with 99mTc-HMPAO than with 123I-IMP. SPECT with both tracers is recommended to follow the evolution of strokes in terms of regional cerebral blood flow and tissue metabolism.
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PMID:"Luxury perfusion" with 99mTc-HMPAO and 123I-IMP SPECT imaging during the subacute phase of stroke. 230 69

The role of 123I-N-isopropyl-p-iodoamphetamine (123I-IMP), a new agent used in brain imaging with single-photon emission computed tomography (SPECT), has been assessed in the early diagnosis of acute infarctive stroke and Alzheimer's disease (AD). The diagnosis of these conditions in their early stages has remained problematic, principally due to limitations of existing technologies. To more formally assess this new technology, we estimated the sensitivity and specificity of 123I-IMP SPECT scanning in the diagnosis of stroke and AD. We based our assessment on a review of all published studies that reported on 123I-IMP SPECT scans and which included three or more patients. The results from three major studies indicate that 123I-IMP SPECT scanning has a higher sensitivity (92% to 100%) than computerized tomography (55% to 86%) in the early diagnosis of acute cerebral infarction. Preliminary findings from studies using 123I-IMP SPECT in the diagnosis of early AD are promising and show a sensitivity of at least 69%. Furthermore, 123I-IMP SPECT scanning clearly discriminates patients with advanced AD from normals: sensitivity has ranged from 50% to 100%, while specificity has ranged from 97% to 100%. Studies also suggest that it can discriminate AD patients from those with multi-infarct dementia. Our review indicates that 123I-IMP SPECT may have an important future role in the early diagnosis and management of patients with acute infarctive stroke and AD.
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PMID:An assessment of the role of 123I-N-isopropyl-p-iodoamphetamine with single-photon emission computed tomography in the diagnosis of stroke and Alzheimer's disease. 266 71

Single-photon emission computed tomography with N-isopropyl[123I]-p-iodoamphetamine (IMP-SPECT) was performed in 14 normal volunteers (seven men and seven women aged 25.1 +/- 5.3 years) and 29 patients with cerebrovascular disease (18 men and 11 women aged 54.1 +/- 13.7 years). The fluid microsphere model was used to estimate cerebral blood flow (CBF). Normal subjects were scanned twice, 1 week apart, to determine the reproducibility of the CBF estimates. Hemispheric blood flow (hCBF) was calculated as the mean of regional cerebral blood flow (rCBF) values in 16 gray matter regions per hemisphere. In normal subjects mean hCBF was 68 ml/100 g/min. The highest rCBF was found in the occipital cortex, followed by the frontal, temporal, and parietal cortexes. CBF values were reproducible (p less than 0.001 except the right thalamic region, where p less than 0.01). Intraindividual variation ranged between 0.3% and 15%. Women exhibited significantly higher (16%, p less than 0.02) CBF than men. Patients were subdivided into groups with reversible (n = 19) and persistent (n = 10) symptoms. Significant hCBF differences between the affected and the contralateral hemispheres were recorded only in the group with reversible symptoms (p less than 0.005), whereas the group with persistent symptoms showed a significant bilateral decrease of hCBF compared with normal subjects and patients with reversible symptoms. Focal CBF was significantly lower in patients with completed stroke than in patients with transient symptoms (p less than 0.001). Our results indicate that IMP-SPECT can be used for the routine estimation of CBF in normal and pathologic states.
Stroke 1989 Feb
PMID:Quantification of regional cerebral blood flow with IMP-SPECT. Reproducibility and clinical relevance of flow values. 278 13

Somatosensory evoked potentials (SEP) were examined in 140 patients suffering from cerebro-vascular ischemic disease. Patients were classified in 1. asymptomatic stenosis/occlusion, 2. complicated migraine, 3. transient ischemic attacks (TIA), 4. reversible ischemic neurologic deficit (RIND), 5. completed stroke and 6. Multiinfarct-dementia. Normal SEP values were obtained from 26 age-correlated normal persons without a history of neurologic or psychiatric disease. The findings were correlated to clinical data, EEG, Single-Photon Emission and Transmission Computertomography (SPECT, TCT). SEP were done by stimulation of the median nerve. We evaluated central conduction time (CCT), amplitude ratio (AR) and number of phases (PHAS) of cortical potentials within 50 ms. Also quotient of amplitude ratio left stimulation side to right stimulation side (AR l/r) was calculated. EEG were recorded by 19 electrodes according to the 10-20 scheme, focal signs and diffuse changes were evaluated. In TCT the location of hypodense lesions was evaluated. SPECT was performed by application of J123 IMP and Tc99 HMPAO as a tracer. Focal decrease of tracer uptake compared to the compartment was evaluated. Results of animal experiments and clinical studies are discussed in respect of patients and methods.
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PMID:[Early somatosensory evoked potentials in ischemic cerebrovascular diseases--I: Methodology, patients, normal group and review of the literature]. 283 58

SPECT imaging of [123I]IMP is reviewed. Methods for radiopharmaceutical production are discussed with an emphasis on labeling small quantities of IMP. Limited angle tomography and full angle SPECT with standard cameras and special imaging systems are reviewed. Selection of collimator and methods of reconstruction are discussed. Clinical studies are described with emphasis on stroke, epilepsy and dementia. The efforts to perform quantitative imaging of rCBF with [123I]IMP are reviewed.
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PMID:[123I]iodoamphetamine SPECT imaging. 302 77

Although IMP scans fail to show fine anatomical details of the brain, because of poor resolution of a single head rotational system, adequate information is offered by the scans to localize most perfusion defects caused by stroke. The following conclusions can be drawn from our study: 1. The planar IMP brain scans processed through the computer are sensitive in the early diagnosis of acute stroke except for small and deeply localized lesions. 2. The SPECT IMP imaging is more sensitive than the planar or transmission CT scans in the early diagnosis of stroke. Semiquantitative evaluations are feasible with IMP SPECT. 3. Neither transmission CT nor IMP SPECT are sensitive in the detection of acute lacunar infarcts. 4. In acute infarction, the transmission CT is usually negative or minimally positive in the early stages, while impaired uptake of IMP occurs immediately after the onset of the stroke. In acute stroke, the extent of the perfusion defect on IMP is usually greater than the abnormality seen on the transmission CT. 5. On followup studies, IMP scans show improved perfusion reflecting physiologic changes, while transmission CT scans show further dense anatomical changes when compared to the initial studies. 6. Hyperemic changes are likely due to collateral circulation or luxury perfusion. This finding suggests that the IMP reflects local cerebral blood flow in strokes.
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PMID:Iofetamine HCI I-123 brain scanning in stroke: a comparison with transmission CT. 325 4

The uptake of 123I-amphetamine (IMP) in brain mainly corresponds to regional perfusion. Distribution of IMP can be visualized in tomographic slices by single-photon emission computed tomography (SPECT). For better evaluation and comparison in follow-up studies, right/left ratios were computed and an asymmetry index calculated. The most sensitive asymmetry index was achieved by 120 average circumferential profiles. In 52 patients with stroke and 16 controls the respective sensitivities of IMP-SPECT, computed tomography (CT), static and dynamic brain scanning and angiography were evaluated. In patients with TIA and PRIND the IMP-SPECT had the highest sensitivity of all non-invasive methods. In patients with completed stroke, the sensitivity of IMP-SPECT was comparable with that of CT (90 vs. 93%). There was a significant correlation between the IMP asymmetry index and the clinical and social score (p less than 0.001). The IMP asymmetry index was significantly correlated to the size of the CT lesion (p less than 0.001). In most patients, the size of the IMP lesion was larger than that of CT. In a prospective study, 28 patients with completed stroke were examined. 14 patients underwent surgical treatment (6 endarterectomies, 5 EIA, 3 combined operations), 14 patients had medical treatment only. Both groups were reexamined after 10 and 6.5 months, respectively. In both groups, neither the IMP asymmetry index nor the size of the CT lesion were changed, but the clinical and social scores improved (p less than 0.01). The outcome in both groups was the same. A positive effect of surgery could not be demonstrated.
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PMID:[Single-photon emission tomography (SPECT) using 123I-amphetamine in cerebral ischemic circulatory disorders]. 349 87


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