Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Assess the safety and efficacy of the continuous transcranial duplex Doppler (TCDD) monitoring of middle cerebral artery (MCA) (M1-2) occlusion in acute ischemic stroke (IS) patients and compare TCDD to intra-arterial thrombolysis (IAT) and intravenous thrombolysis (IVT). ⋯ Continual TCDD monitoring might be safe and potentially beneficial in treatment of MCA occlusion.
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Double Inversion Recovery Magnetic Resonance Imaging (DIR) consists of two adiabatic non-selective inversion pulses applied before a Turbo Spin Echo (TSE) sequence, in order to suppress the signal from two tissues with different longitudinal relaxation times T(1) simultaneously. In the brain, DIR is used to selectively image the gray matter (GM) by nulling the signal from white matter (WM) and cerebrospinal fluid (CSF). The main limitation of the technique remains the intrinsic low SNR due to the specific preparation of the longitudinal magnetization. The recent availability of high field magnets operating at 7 T for human imaging offers the advantage of higher SNR. This study shows the feasibility of brain Double Inversion Recovery Magnetic Resonance Imaging (DIR-MRI) at 7 T in vivo in healthy volunteers. ⋯ DIR is feasible at 7 T despite the problems associated with B(1) in-homogeneity.
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Cerebral venous thrombosis is a rare condition. Its diagnosis and management can be difficult. Treatment options include systemically delivered anticoagulation or thrombolysis. Intrasinus thrombolysis is an increasingly used intervention but it increases the risk of hemorrhage, especially in patients who have a rapidly deteriorating neurological condition. Mechanical thrombectomy that provides rapid canalization without increased risk of hemorrhage is an attractive alternative treatment. ⋯ Intracranial hemorrhage or a rapidly deteriorating neurological condition may preclude the use of thrombolytic agents in the treatment of patients with cerebral venous sinus thrombosis. In such patients, mechanical thrombectomy offers a useful alternative.
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The prevalence and natural history of asymptomatic intracranial arterial stenosis are not very well characterized. Existing data suggest that incidentally discovered asymptomatic intracranial stenosis presents a fairly low risk of stroke, though substantial uncertainty remains. ⋯ Methods to stratify the risk of stroke with asymptomatic intracranial atherosclerotic lesions have yet to be established and validated. In general, aggressive intervention for an asymptomatic intracranial stenosis is not currently recommended.
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Case Reports
Transcranial Doppler sonography: abnormal waveform pattern of intracranial arteries in acute aortic arch dissection.
We describe an interesting pattern of transcranial Doppler (TCD) intracranial blood flow waveforms in a patient with an acute aortic arch type A dissection. A 49-year-old patient presented with a low blood pressure after a syncopal episode, severe chest pain, and mild left hemiparesis. ⋯ TCD revealed an abnormal waveform pattern recorded in middle cerebral, internal carotid, and anterior cerebral arteries bilaterally with a pre-systolic sharp wave that gave the appearance of duplicated systolic phase. Our finding adds another interesting pattern of hemodynamic changes in cerebral circulation in patients with acute aortic arch dissections.