Prognostic value of a qualitative brain MRI scoring system after cardiac arrest.

Background And Purpose: To develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice.

Methods: Consecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored by two independent blinded experts.

Natural history and prognostic value of corticospinal tract Wallerian degeneration in intracerebral hemorrhage.

Background: The purpose of this study was to define the incidence, imaging characteristics, natural history, and prognostic implication of corticospinal tract Wallerian degeneration (CST-WD) in spontaneous intracerebral hemorrhage (ICH) using serial MR imaging.

Methods And Results: Consecutive ICH patients with supratentorial ICH prospectively underwent serial MRIs at 2, 7, 14, and 21 days. MRIs were analyzed by independent raters for the presence and topographical distribution of CST-WD on diffusion-weighted imaging (DWI).

Serum neuron-specific enolase levels from the same patients differ between laboratories: assessment of a prospective post-cardiac arrest cohort.

Background: In comatose post-cardiac arrest patients, a serum neuron-specific enolase (NSE) level of >33 μg/L within 72 h was identified as a reliable marker for poor outcome in a large Dutch study (PROPAC), and this level was subsequently adopted in an American Academy of Neurology practice parameter. Later studies reported that NSE >33 μg/L is not a reliable predictor of poor prognosis. To test whether different clinical laboratories contribute to this variability, we compared NSE levels from the laboratory used in the PROPAC study (DLM-Nijmegen) with those of our hospital's laboratory (ARUP) using paired blood samples.

Magnetic resonance imaging profile of blood-brain barrier injury in patients with acute intracerebral hemorrhage.

Background: Spontaneous intracerebral hemorrhage (ICH) is associated with blood-brain barrier (BBB) injury, which is a poorly understood factor in ICH pathogenesis, potentially contributing to edema formation and perihematomal tissue injury. We aimed to assess and quantify BBB permeability following human spontaneous ICH using dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). We also investigated whether hematoma size or location affected the amount of BBB leakage.

Extent of hypoattenuation on CT angiography source images in basilar artery occlusion: prognostic value in the Basilar Artery International Cooperation Study.

Background And Purpose: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS).

Methods: BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion.

A comparison of cooling techniques to treat cardiac arrest patients with hypothermia.

Introduction. We sought to compare the performance of endovascular cooling to conventional surface cooling after cardiac arrest. Methods.

Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging.

Background And Purpose: knowledge on the natural history and clinical impact of perihematomal edema (PHE) associated with intracerebral hemorrhage is limited. We aimed to define the time course, predictors, and clinical significance of PHE measured by serial magnetic resonance imaging.

Methods: patients with primary supratentorial intracerebral hemorrhage ≥ 5 cm(3) underwent serial MRIs at prespecified intervals during the first month.

Nontraumatic intracranial hemorrhage.

Nontraumatic (or spontaneous) intracranial hemorrhage most commonly involves the brain parenchyma and subarachnoid space. This entity accounts for at least 10% of strokes and is a leading cause of death and disability in adults. Important causes of spontaneous intracranial hemorrhage include hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformations, and hemorrhagic infarcts (both venous and arterial).

MRI profile of the perihematomal region in acute intracerebral hemorrhage.

Background And Purpose: The pathophysiology of the presumed perihematomal edema immediately surrounding an acute intracerebral hemorrhage is poorly understood, and its composition may influence clinical outcome. Method-Twenty-three patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were prospectively enrolled and studied with MRI. Perfusion-weighted imaging, diffusion-weighted imaging, and fluid-attenuated inversion recovery sequences were coregistered.

Prognosis after cardiac arrest and hypothermia: a new paradigm.

Before the use of hypothermia as a treatment for comatose post-cardiac arrest patients, several prognostic variables were widely accepted as reliable and valid for the prediction of poor outcome. Recent studies using hypothermia have reported on patients with recovery of consciousness in spite of absent or extensor motor responses after 3 days, absent bilateral cortical N20 responses after 24 h, serum neuron-specific enolase levels greater than 33 μg/L, and early myoclonus status epilepticus. Hypothermia and its associated use of sedative and paralytic agents may delay neurologic recovery and affect the optimal timing of prognostic variables.

Utility of early MRI in the diagnosis and management of acute spontaneous intracerebral hemorrhage.

Background: The optimal diagnostic evaluation for spontaneous intracerebral hemorrhage (ICH) remains controversial. In this retrospective study, we assessed the utility of early magnetic resonance imaging (MRI) in ICH diagnosis and management.

Methods: Eighty-nine (72%) of 123 patients with spontaneous ICH underwent a brain CT and MRI within 30 days of ICH onset.

Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results.

Background And Purpose: Induced hypothermia is a promising neuroprotective therapy. We studied the feasibility and safety of hypothermia and thrombolysis after acute ischemic stroke.

Methods: Intravenous Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke (ICTuS-L) was a randomized, multicenter trial of hypothermia and intravenous tissue plasminogen activator in patients treated within 6 hours after ischemic stroke.

Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia.

Background: Therapeutic hypothermia is commonly used in comatose survivors' post-cardiopulmonary resuscitation (CPR). It is unknown whether outcome predictors perform accurately after hypothermia treatment.

Methods: Post-CPR comatose survivors were prospectively enrolled.

Temporal and spatial profile of brain diffusion-weighted MRI after cardiac arrest.

Background And Purpose: Diffusion-weighted magnetic resonance imaging of the brain is a promising technique to help predict functional outcome in comatose survivors of cardiac arrest. We aimed to evaluate prospectively the temporal-spatial profile of brain apparent diffusion coefficient changes in comatose survivors during the first 8 days after cardiac arrest.

Methods: Apparent diffusion coefficient values were measured by 2 independent and blinded investigators in predefined brain regions in 18 good- and 15 poor-outcome patients with 38 brain magnetic resonance imaging scans and were compared with those of 14 normal controls.

Crossed cerebellar diaschisis in status epilepticus.

Background: Crossed cerebellar diaschisis (CCD) has been reported on positron-emission tomography and single-photon emission computed tomography of stroke patients. Rarely it has been described with brain diffusion-weighted MRI (DWI) of status epilepticus (SE).

Methods: Case report.

Favorable outcome from a locked-in state despite extensive pontine infarction by MRI.

Introduction: Outcome prediction of patients who are in a locked-in state is challenging. Extensive pontine infarction on diffusion weighted imaging MRI (DWI) has been proposed as a poor prognosticator. We report on three patients with a locked-in state with unexpected favorable recoveries despite DWI evidence of widespread pontine ischemia.

Fatal massive cerebral air embolism in a lung transplant patient.

Introduction: Massive air embolism has been described in multiple clinical scenarios, especially in critical ill patients who undergo invasive procedures. Nevertheless, air embolism is often unrecognized and a high index of suspicion is required to diagnose this entity. Two previous cases of air embolism in lung transplant patients have been described in the literature; we describe a third case of fatal massive air embolism and cardiovascular collapse in a lung transplant patient.

Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study.

Background: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO.

Methods: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007.

Profiles of neurological outcome prediction among intensivists.

Background: Advances in intensive care medicine have increased survival rates of patients with critical neurological conditions. The focus of prognostication for such patients is therefore shifting from predicting chances of survival to meaningful neurological recovery. This study assessed the variability in long-term outcome predictions among physicians and aimed to identify factors that may account for this variability.

Prognostic value of brain diffusion-weighted imaging after cardiac arrest.

Objective: Outcome prediction is challenging in comatose postcardiac arrest survivors. We assessed the feasibility and prognostic utility of brain diffusion-weighted magnetic resonance imaging (DWI) during the first week.

Methods: Consecutive comatose postcardiac arrest patients were prospectively enrolled.

The basilar artery international cooperation study (BASICS).

Unlabelled: Basilar artery occlusion is a rare cause of stroke with a high case fatality rate and an often poor clinical outcome among survivors. Our limited knowledge on the outcome in patients with basilar artery occlusion comes from small case series of selected patients.

Study Aim: The main purpose of the registry is to collect preliminary data that will help direct the design of a future clinical treatment trial.

Management of acute ischemic stroke.

Stroke is the third leading cause of death and the leading cause of disability in the United States. This article summarizes the management of acute ischemic stroke, including conventional and novel therapies. The article provides an overview of the initial management, diagnostic work-up, treatment options, and supportive measures that need to be considered in the acute phase of ischemic stroke.

Risk factors of symptomatic intracerebral hemorrhage after tPA therapy for acute stroke.

Background: Studies evaluating predictors of tPA-associated symptomatic intracerebral hemorrhage (SICH) have typically focused on clinical and CT-based variables. MRI-based variables have generally not been included in predictive models, and little is known about the influence of reperfusion on SICH risk.

Methods: Seventy-four patients were prospectively enrolled in an open-label study of intravenous tPA administered between 3 and 6 hours after symptom onset.