Journal of neuroimaging : official journal of the American Society of Neuroimaging
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High-resolution magnetic resonance images obtained in a patient several months after carbon monoxide (CO) intoxication revealed nearly symmetric regional atrophy of both lateral temporal lobes. This pattern of cortical lesions after CO exposure has not been reported before. The patient suffered from severe cognitive deficits including a transient Klüver-Bucy-like behavior. This report underlines the value of high-resolution magnetic resonance imaging in chronic stages of CO intoxication in the attempt to understand the neuroanatomical bases of the observed behavior.
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The authors establish accuracy parameters of a broad diagnostic battery for bedside transcranial Doppler (TCD) to detect flow changes due to internal carotid artery (ICA) stenosis or occlusion. ⋯ In symptomatic patients, bedside TCD can accurately detect flow changes consistent with hemodynamically significant ICA obstruction; however, TCD should not be a substitute for direct carotid evaluation. Because TCD is sensitive and specific for a > or = 70% carotid stenosis or occlusion in both extracranial and intracranial carotid segments, it can be used as a complementary test to refine other imaging findings and detect tandem lesions.
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Randomized Controlled Trial Multicenter Study Clinical Trial
SonoVue in transcranial Doppler investigations of the cerebral arteries.
The authors investigated the safety and diagnostic potential of a new ultrasound contrast agent (SonoVue) using transcranial color-coded duplex sonography (TCCS). ⋯ The results obtained from this multicenter study demonstrate that the administration of SonoVue to patients with ischemic cerebrovascular disease who undergo TCCS examination of cerebral vessels improves the visualization of intracranial arteries, providing a dose-dependent contrast enhancement and a clinically useful duration of signal enhancement related to the dose. During this multicenter study, SonoVue proved to be a safe and well-tolerated compound.
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Comparative Study
Transcranial Doppler pulsatility indices as a measure of diffuse small-vessel disease.
Elevation in pulsatility indices (PIs) as measured by transcranial Doppler (TCD) have been postulated to reflect downstream increased vascular resistance caused by small-vessel ischemic disease. ⋯ Elevation in PIs as measured by TCD shows strong correlation with MRI evidence of small-vessel disease. TCD may be a useful physiologic index of the presence and severity of diffuse small-vessel disease.
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A patient with mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode (MELAS) syndrome underwent serial measurement of cerebral blood flow with xenon computed tomography (Xe-CBF) while presenting with strokelike episodes accompanied by a cerebral lesion. He underwent positron emission tomography (PET) measurement of the regional cerebral blood flow (PET-CBF), metabolic rate of oxygen (CMRO2), and glucose (CMRGlu) after his symptoms and lesion disappeared. ⋯ In the PET study, decreased CMRO2 and increased PET-CBF and CMRGlu were noted in the entire brain. The strokelike episodes of patients with MELAS are more likely attributed to the failure of oxygen metabolism than to a vascular accident.