Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Electroencephalography (EEG) is traditionally used to assess the duration of hemispheric anesthetization and to monitor return of function in the anesthetized hemisphere during the intracarotid amobarbital procedure (IAP), but EEG changes are not consistently seen. The authors evaluated the role of continuous transcranial Doppler (TCD) monitoring as an alternative to EEG. ⋯ Continuous TCD monitoring may be a more sensitive method than EEG in determining the duration of hemispheric anesthetization during IAP. Because the items for assessment of memory are presented during the period of hemispheric anesthetization, TCD may be useful in more precisely defining the time window for memory testing.
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It has been suggested that intravenous tissue plasminogen activator (TPA) would not lyse the large thrombus associated with internal carotid artery (ICA) occlusion and, therefore, would be ineffective in this setting. Vascular imaging, safety, and outcome of TPA therapy for ICA occlusion is not well described. Our goal was to determine the site of occlusion, early recanalization after TPA infusion, and its relationship to outcome. ⋯ Most patients did not recanalize their ICA occlusion after intravenous TPA therapy. However, recanalization of associated proximal MCA clot, found in 45% of our patients, or improved MCA collateral flow was strongly associated with good outcome.
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To evaluate visualization and signal characteristics of macroscopic changes in patients with ophthalmologically stated papilledema and to find a suitable high-resolution magnetic resonance imaging (MRI) protocol. ⋯ An MRI protocol consisting of a 5-mm transverse T2w TSE sequence; a T2*w, 3D CISS sequence; a T1w, 3D MP-RAGE sequence with and without contrast medium; and a transverse T1w, (2-mm) 2D TSE sequence with fat-suppression technique with intravenous contrast medium is suitable to visualize the macroscopic changes in papilledema. In addition, this combination is an excellent technique for the examination of the orbits and the brain.
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The insonation of the posterior communicating artery (PcomA) is often hampered by the unfavorable insonation angle when the temporal acoustic bone window (TBW) is used. This problem may be ameliorated by a lateral frontal bone window (LFBW). This study evaluated the TBW and LFBW for the assessment of collateral intracranial flow conditions and aimed at defining diagnostic transcranial color-coded duplex sonography (TCCS) criteria that do not need compression maneuvers. ⋯ The LFBW proved useful as a complementary insonation plane to assess intracranial crossflow conditions, especially via the PcomA. We were able to define TCCS criteria for functional relevant collateralization without the need of compression maneuvers.
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Unilateral pain in the cervical region and limitation of neck movements are nonspecific symptoms frequently encountered in daily medical practice. Vertebral artery dissection is rarely considered as a diagnostic possibility unless brainstem or cerebellar ischemia follows the acute pain. Three cases of vertebral artery dissection (VAD) having the sole complaint of pain of acute onset in the posterior neck region are presented. ⋯ Severe neck pain and/or occipital headache frequently accompanies ischemic symptoms in cases with VAD. The cases in this report emphasize that spontaneous and often unilateral posterior cervical pain of acute onset can be the only manifestation of a VAD. A high degree of suspicion especially in young patients with no past history of a similar pain can help to establish the diagnosis, thereby preventing erroneous and potentially hazardous therapeutic interventions such as physiotherapy or neck manipulation.