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

The annual incidence of stroke in the elderly approaches 2 per cent. The major tasks of the physician are to attempt to prevent recurrence and to supervise rehabilitation. Prevention of recurrence involves a careful consideration of differential diagnosis, treatment of contributory disease, and the initiation of therapy specific to large vessel infarction (atherothrombotic or cardiogenic embolic), lacunar infarction, or intracerebral hemorrhage. The high prevalence of lacunar infarction and the focal nature of posterior circulation transient ischemic attacks and strokes are not generally appreciated. Cardiogenic embolism due to atrial fibrillation and intracerebral hemorrhage due to congophilic angiopathy are of particular importance in the elderly. Treatment of stroke or transient ischemic attacks should be initiated quickly as the risk of recurrence is highest immediately following the signal event. History, neurologic and neurobehavioral examinations are important adjuncts in compensating for the inadequacy of CT and MRI in enabling the stroke classification necessary for proper treatment. Supportive care and rehabilitation can have a major impact on stroke morbidity and mortality and the management of risk factors can significantly reduce stroke incidence.
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PMID:Stroke. 268 65

Today, two types of cardiac imaging may be obtained in MRI. The spin-echo technique with ECG dependency permits to obtain multiple sections in all spatial planes; the morphology of the heart cavities may then be evaluated as well as the condition of the myocardium (thickness, signal, movements). The gradient-echo technique permits a quick imaging or cine-MRI. 16 to 32 images per cardiac cycle are obtained: therefore, analysis of the flows, turbulence and regurgitations. Early developments involve computer sciences: automatic analysis of the heart cavities (volume, stroke volume, etc.) and regurgitations in order to quantify them. Comparative trials show a good correlation with standard explorations. Late developments at 4-5 years: these are newly acquired techniques such as echo planar (spirals of Fourier's plane) permitting to obtain in one second, 8 stages of the heart cycle. This would then be a true and fast cardiac recording. The same techniques of computer analysis will permit to obtain precise measurements.
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PMID:[Cardiac imaging using magnetic resonance]. 268 23

Clinical studies using 31P and 1H MRS with a whole body 2.0 T MRI/MRS system are described. In most cases, techniques to quantitate absolute molar concentrations of metabolites in various organs were used. In the brain, AIDS, chronic stroke, and white matter lesions were associated with alterations of brain 31P metabolites. Epilepsy was associated with increased pH in the seizure focus. In the heart, dilated cardiomyopathy was associated with increased PDE/ATP while PCr/ATP was unchanged. In the liver, alcoholic hepatitis and cirrhosis were associated with diminished hepatic ATP while alcoholic hepatitis had increased pH and cirrhosis had decreased pH. This allowed differentiation of normal liver, alcoholic hepatitis, and alcoholic cirrhosis without biopsy. In the prostate, malignancy was associated with increased PME/ATP and decreased PCr/ATP. The PME/PCr was greatly increased in malignant prostate with no overlap in normals. Other cancers outside the brain had increased PME and effective treatment was often associated with diminished PME. 1H MRS of the brain was performed using ISIS and outer volume suppression pulses for volume localization. Excellent high resolution 1H water-suppressed spectra were obtained at echo times as short as 30 ms, showing well resolved peaks for lactate, N-acetylaspartate, glutamate, choline, creatinine, and inositol. 1H MRS demonstrated that the uptake of ethanol by the brain was slower than the rise of ethanol in blood. 31P spectroscopic imaging of the brain with resolution of 2.25 x 2.25 x 2.5 cm produced metabolic images and high resolution spectra from desired regions of interest.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical magnetic resonance spectroscopy of brain, heart, liver, kidney, and cancer. A quantitative approach. 270 9

This article, aimed toward the nonneurologist specialist, presents current indications for MRI in the CNS. Primary and metastatic brain tumors, white matter disease, stroke and hemorrhage, hydrocephalus, and spinal disease are discussed. Emphasis is placed on the contribution of MRI to the evaluation of these major classes of disease. Because of its improved sensitivity and noninvasiveness, in most instances MRI is the initial imaging procedure of choice in the CNS.
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PMID:Magnetic resonance imaging in the CNS. 274 80

We present a patient who experienced sudden onset of orbital headache, visual loss and bitemporal visual field defect. MRI of the optic chiasm suggested a diagnosis of haemorrhage and hence a vascular malformation. Pterional craniotomy revealed an intrachiasmatic haematoma with a cavernous angioma. The malformation was totally excised and vision improved after surgery. The syndrome of chiasmal apoplexy is discussed.
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PMID:Chiasmal apoplexy: haemorrhage from a cavernous malformation in the optic chiasm. 279 81

To investigate cerebral hemodynamics in sickle cell disease (SCD), we used the 133Xenon inhalation technique of quantifying cerebral blood flow (CBF) in 67 patients. Clinical examinations and cerebral magnetic resonance imaging also were performed in all patients. Compared with age-matched healthy controls, CBF was elevated by 68% in patients, and inversely related to hematocrit. An experimental index of cerebral blood volume, pr4, was also elevated in the patients in a similar manner. Cerebral blood volume was positively correlated to CBF in SCD patients but not in controls. History of stroke and current neurologic symptoms were associated with lower flow and higher cerebral blood volume. Transfusion therapy reduced the hyperemia, the reduction being greater than expected by hematocrit elevation alone. These findings document a vasodilatory hyperemia in SCD. This dilatation may be a risk factor for ischemic distal-field infarctions, as visualized by MRI, due to a limitation of cerebrovascular reserve capacity.
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PMID:Cerebral hyperemia, stroke, and transfusion in sickle cell disease. 292 41

The results of MRI and CT in 55 patients with brain infarcts were compared; in 26 of these cases an additional PET examination was obtained in order to study the regional glucose utilisation. MRI was superior to CT, demonstrating 11% more of the infarcts, particularly during the first 24 hours, in small lesions confined to the grey or subcortical white matter and in infratentorial ischemic lesion. On the other hand, only CT was able to show fresh hemorrhage, although MRI was the method of choice to demonstrate old blood collections. To characterise the follow up of an infarct, CT and MRI were similar, except the marginal contrast enhancement sometimes demonstrated by CT studies between the 2nd and 4th week after stroke event. PET was inferior to show details because of its poorer spatial resolution, but anyhow had a high sensitivity and provided additional informations concerning secondary inactivations of brain areas not directly damaged. Additionally PET was able to demonstrate areas of anaerobic glycolysis and lesions of diminished glucose utilisation in TIAs. Small areas of gliosis in the white matter of the cerebral hemispheres were frequently found in patients with cerebro-vascular diseases; they were best shown by MRI, but do not correlate with the extent of vascular stenoses or occlusions, shown by angiography.
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PMID:[MR of ischemic brain diseases. A comparison with CT, PET (18-fluorodeoxyglucose) and angiographic results]. 301 55

The invention of the Anger scintillation camera and the development of 99mTc tracers brought about a tenfold increase in nuclear brain scanning between 1963 and 1973, an increase that plateaued with the introduction of x-ray computed tomography. A second growth curve began in 1976 at which time there were four PET centers in the United States, a number that grew to 60 worldwide over the next decade. PET, SPECT, MRI, and MRS are leading us into a new era of in vivo brain chemistry, based on regional bioenergetics and neurotransmission. The immediate impact is in epilepsy, stroke, brain tumors and the dementias, with psychiatric diseases becoming a major focus of research. Receptivity has become a biochemical as well as a psychological approach to mental functions. The finding of elevated D2 dopamine receptors in schizophrenia in living patients may be the forerunner of a new biochemical approach to psychiatry.
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PMID:Images of the brain: past as prologue. 302 64

Infarction in the territory of the anterior choroidal artery (AchA) has been the subject of several recent reports. To the classical clinical syndrome of hemimotor, hemisensory, and visual field deficit has been added hemiataxia acute pseudobulbar mutism, pure motor and pure sensory syndromes and disorders of higher cortical function. The definition of anatomic and clinical correlates to AchA stroke is aided by CT-MRI findings and reveals an unexpected superior extension of infarct to include the periventricular caudate nucleus and inferior corona radiata. Prognosis depends upon unilaterally, bilateral strokes having often a fatal outcome. Etiology and treatment may be intimately related to hypertension.
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PMID:A new view of anterior choroidal artery territory infarction. 306 61

This is a case report on a patient with MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes). This study documents, by CT scan, the progression of the disease for 7 years. The first CT scan was normal; all subsequent CT scans were pathological. In addition, one MRI study was done.
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PMID:[The MELAS syndrome. Computed tomographic documentation of its course and magnetic resonance tomography]. 319 17


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