Impact of neuroradiologist second opinion on staging and management of head and neck cancer.

Objective: Patients with head and neck cancer frequently present to academic tertiary referral centers with imaging studies that have been performed and interpreted elsewhere. At our institution, these outside head and neck imaging studies undergo formal second opinion reporting by a fellowship-trained academic neuroradiologist with expertise in head and neck imaging. The purpose of this study was to determine the impact of this practice on cancer staging and patient management.

Combined full-dose IV and endovascular thrombolysis in acute ischaemic stroke.

Background: There is an increasing trend to treating proximal vessel occlusions with intravenous-inter-arterial (IV-IA) thrombolysis. The best dose of IV tissue plasminogen activator (tPA) remains undetermined. We compared the combination of full-dose IV recombinant tissue plasminogen activator (rtPA) and IA thrombolytic therapy to IA therapy.

Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke.

Introduction: Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.

Methods: Patients who underwent intra-arterial procedures with a self-expanding, fully retrievable stent for acute ischemic strokes at our center in 2009 were included in this study.

Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke.

Introduction: The Penumbra system is a newly approved mechanical device for the treatment of acute stroke designed for better and faster recanalization. We describe our initial experience with the use of this device.

Methods: We studied 27 consecutive patients with acute ischemic strokes due to arterial occlusions presenting at our center from January to October 2009.

Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score.

Background: In ischemic stroke, functional outcomes vary depending on site of intracranial occlusion. We tested the prognostic value of a semiquantitative computed tomography angiography-based clot burden score.

Methods: Clot burden score allots major anterior circulation arteries 10 points for presence of contrast opacification on computed tomography angiography.

Communicating hydrocephalus after endovascular coiling of unruptured aneurysms: report of 2 cases.

To the authors' knowledge, only 1 case of communicating hydrocephalus after endovascular coiling of unruptured brain aneurysms has been reported previously. Here, they report on 2 such cases of delayed communicating hydrocephalus after treatment with hydrogel-coated coils and offer the first histopathological evidence of foreign material, presumably related to the coils, as the cause of hydrocephalus.

Assessment of brain aneurysms by using high-resolution magnetic resonance angiography after endovascular coil delivery.

Object: Digital subtraction (DS) angiography is the current gold standard of assessing intracranial aneurysms after coil placement. Magnetic resonance (MR) angiography offers a noninvasive, low-risk alternative, but its accuracy in delineating coil-treated aneurysms remains uncertain. The objective of this study, therefore, is to compare a high-resolution MR angiography protocol relative to DS angiography for the evaluation of coil-treated aneurysms.

MR angiography compared to conventional selective angiography in acute stroke.

Background And Purpose: Accuracy of intracranial magnetic resonance angiography (MRA) and reliability of interpretation are not well established compared to conventional selective catheter angiography. The purpose of this study was to determine the accuracy of MRA in evaluation of intracranial vessels in acute stroke and transient ischemic attack (TIA) patients

Methods: Twenty-nine patients (seven females, 22 males; median age 53) with acute stroke or TIA were enrolled into the study. All patients underwent both MRA using a 3 T clinical magnet and conventional angiography within 48 hours.

ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome.

Background And Purpose: The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system to assess ischemic changes on CT in acute ischemic stroke. CT angiography-source images (CTA-SI) predict final infarct volume. We examined whether the final infarct ASPECTS and clinical outcome were more related to acute CTA-SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS.

Thunderclap headache and reversible segmental cerebral vasoconstriction associated with use of oxymetazoline nasal spray.

Oxymetazoline is a sympathomimetic amine found in over-the-counter nasal decongestants. We report a case of chronic use of nasal oxymetazoline associated with thunderclap headache due to reversible segmental intracranial vasoconstriction.

Intra-arterial thrombolysis in acute ischemic stroke: a review of pharmacologic approaches.

Ischemic stroke is a major public health problem worldwide. The potential to cure stroke patients with intravenous thrombolytic therapy has evolved to the use of intra-arterial thrombolytic agents. Fewer than 200 patients have been enrolled in randomized trials of intra-arterial therapy.

Mild neurological symptoms despite middle cerebral artery occlusion.

Background And Purpose: Only a small percentage of stroke patients are treated with thrombolytic therapy. We sought to determine whether vessel occlusion in mild strokes represented a new target population for interventional therapy.

Methods: We imaged 106 acute stroke patients with MRI.

Reliability of assessing percentage of diffusion-perfusion mismatch.

Background And Purpose: Emergent neurovascular imaging holds promise in identifying new and optimum target populations for thrombolysis in stroke. Recent research has focused on patients with diffusion-weighted MRI (DWI)-perfusion-weighted MRI (PWI) mismatch as a marker of tissue at risk of infarction and a means to select the most suitable candidates for thrombolysis. The present study sought to estimate the reliability of assessing the percentage of DWI-PWI mismatch.

What is causing crescendo transient ischemic attacks?

Background And Methods: We discuss a case report from a patient who had symptoms of transient neurological deficits in the presence of a chronic subdural hematoma and severe carotid stenosis. Multi-modality imaging was used to guide management.

Results: The symptoms settled without carotid intervention and were presumed due to the subdural hematoma.

Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusions in acute ischemic stroke.

Background And Purpose: Three-dimensional time-of-flight (TOF) MR angiography is used routinely in stroke workup to detect arterial occlusions, but a major drawback is its inadequate depiction of vessels with slow or in-plane flow. We hypothesized that the use of contrast-enhanced MR angiography improves delineation of vessels with diminished or absent flow on precontrast MR angiograms.

Methods: Pre- and postcontrast 3D TOF MR angiograms were acquired in 55 consecutive patients with acute stroke.

Acute intravenous--intra-arterial revascularization therapy for severe ischemic stroke.

Background: Intravenous alteplase for acute ischemic stroke is least efficacious for patients with proximal large-artery occlusions and clinically severe strokes. Intra-arterial therapy has the theoretical advantage of establishing a neurovascular diagnosis and high symptomatic artery patency rate but the disadvantage of requiring extra time and technical expertise. A combination of these two approaches may provide the best chance of improving outcome in severe acute ischemic stroke.