MRI in diagnostics of failing cerebral perfusion

Background and Purpose: The employment of Magnetic resonance (MR) in investigations of cerebral tissue in health and disease achieved during the last 3 decades great appreciation. Its spectacular results in MR imaging and spectroscopy are especially useful in the domain of brain ischaemia. Materials and Methods: We have combined practical experience with search in literature to create a review of possible examinations in the field of stroke and chronic cerebrovascular insufficiency. Results and Conclusions: Our survay contains chapters on the causes of cerebral ischaemia, described in methods ofMR angiography and Perfusion weighted imaging and chapters on the consequences of ischaemia: Imaging of the ischaemic cascade by classical spin echo sequences, imaging of diffusion, of contrast enhancement and distinction of the surviving parts in the hypoperfused regions. Magnetic resonance spectroscopy is reported in its proton and phosphorus examinations. Longlasting diminushion of cerebral blood flow with aging is reviewed in the last chapter

Liječenje i troškovi moždanog udara u kasnim devedesetim: Sveučilišna bolnica u Pragu

Analysis of 224 stroke admissions during the year 1997 was performed to contribute to the international comparisons in the management of acute stroke. The analysis revealed 83% of patients with cerebral hemorrhage and 37% of those with cerebral infarction to have spent at least several days in the intensive care unit (ICU). The mean length of the hospital stay of 12.7 days differed between men and women, while the mean length of ICU stay differed between cerebral hemorrhage and cerebral ischemia. The intervals between stroke onset and admission and between stroke onset and computed tomography (CT) as well as the percentual employment of various diagnostic methods were evaluated in a subset of 156 cases. Hospital admission with a median of 4 hours and management in case of hemorrhage compared relatively well with international standards, whereas in case of cerebral infarction the use of CT was found to be insufficient, also showing a delay from hospital admission. The overall mortality rate of 10.7% revealed a relatively young mean age of our cohort (61.2 years). The expenses of stroke hospitalization of 1,390 USD were strikingly low as compared with other industrialized countries, which was mainly due to the current exchange rate.Analiza 224 prijma zbog moždanog udara tijekom 1997. godine provedena je kao doprinos međunarodnim usporedbama liječenja akutnog moždanog udara. Analiza je pokazala da je 83% bolesnika s krvarenjem i 37% onih s moždanim infarktom provelo barem nekoliko dana u jedinici intenzivnog liječenja ( JIL). Prosječna duljina boravka u bolnici od 12,7 dana razlikovala se između muškaraca i žena, a prosječna duljina boravka u JIL razlikovala se između bolesnika s krvarenjem i onih s ishemijom. Vremenski razmak od nastupa moždanog udara do prijma u bolnicu te između nastupa moždanog udara i pregleda pomoću kompjutorske tomografije (CT), kao i postotak primjene različitih dijagnostičkih metoda procijenjeni su u podskupini od 156 slučajeva. Prijam u bolnicu s medijanom od 4 sata i liječenje u slučaju krvarenja pokazali su se relativno povoljnima u usporedbi s međunarodnim standardima, dok se u slučaju infarkta naša primjena CT-a pokazala nedostatnom i zakašnjelom u odnosu na prijam u bolnicu. Sveukupna stopa smrtnosti od 10,7% odražava razmjerno mlađu prosječnu životnu dob naših bolesnika (61,2 godine). Izdaci za bolničko liječenje bolesnika s moždanim udarom od 1390 USD vrlo su niski u odnosu na industrijski razvijene zemlje, i to uglavnom zbog sadašnjeg valutnog tečaja