Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Infective endocarditis (IE) is an elusive systemic disorder that is often associated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such findings has been only sparsely described previously. The authors report cranial MRI findings in 12 patients with IE. ⋯ Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in the evaluation of patients with IE. The presence of characteristic cranial MRI lesions, especially of multiple types, may prompt early diagnosis and treatment.
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Transcranial Doppler (TCD) sonography combines the advantages of real-time hemodynamic information, cost-effectiveness, and bedside application. However, measurements can be difficult to reproduce because the spatial resolution and the determination of insonation angles are limited. The purpose of this study was to use the high anatomic resolution of three-dimensional (3D) magnetic resonance angiography (MRA) images for the stereotactic guidance of TCD in order to improve the accuracy and reproducibility of TCD examinations. ⋯ Without navigation the reproducibility of vessel segment insonation dropped to 4.7 mm for the middle cerebral artery and to 4.84 mm for all vessels. The authors conclude that 3D MRA, acquired as an initial procedure in patients with intracranial vascular disorders, can be used to provide stereotactic guidance for repeated TCD examinations. This facilitates the reproducible insonation of specific vessel segments.
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In 1996, a survey of the members of the American Academy of Neurology revealed the following facts and opinions: (1) On an average month, each respondent ordered 15 computed tomography, 22 magnetic resonance imaging, 13 ultrasound and 1 single-photon emission computerized tomography studies. (2) Most respondents did not read their own studies for reimbursement, but relied on their own reading for patient management. (3) Respondents felt that neurologists are appropriate specialists to read imaging studies; however, they favored certification for neurologists credentialed in neuroimaging. (4) Organized neurology should provide certification in neuroimaging for neurologists with appropriate training and defend their right and their need to practice neuroimaging, including endovascular procedures.
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Case Reports
Internal carotid artery dissection causes hypoglossal nerve palsy: CT, MRI, and angiographic findings.
A case of unilateral XIIth nerve palsy due to the dissection of the internal carotid artery is reported. The clinical and radiological features are described. ⋯ Diagnosis is discussed with emphasis on magnetic resonance imaging findings. Magnetic resonance imaging is also useful for follow-up of arterial lesions.
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Comparative Study
Power Doppler compared to color-coded duplex sonography in the assessment of the basal cerebral circulation.
Power-based transcranial duplex sonography (p-TDS) is a new promising ultrasound technique that generates intravascular color signals from the amplitude of the echo signal. The present investigation was undertaken to determine the advantages and limitations of power Doppler in the assessment of the basal cerebral circulation compared with transcranial color-coded real-time sonography (TCCS) and contrast-enhanced transcranial color-coded real-time sonography (CE-TCCS). Thirty-eight patients without cerebrovascular diseases were examined with p-TDS and TCCS, and in 11 patients CE-TCCS studies were performed. ⋯ In comparison with CE-TCCS, p-TDS had no important advantages in the detection of intracranial vessels. In conclusion, p-TDS and CE-TCCS were superior to TCCS with regard to identification of the basal arterial circulation. Both methods permit noninvasive and reliable identification of the basal cerebral circulation.