Early signs of acute middle cerebral artery ischemia in computerized tomography and diffusion weighted magnetic resonance

Background: Stroke is one of the most frequent causes of death and invalidity. The introduction of anticoagulation treatment which improves patient's recovery has set new demands for diagnostic neuroimaging. The aim of the study was to assess diagnostic value of computerized tomography in evaluation of early cerebral changes in middle cerebral artery ischemia and application of diffusion weighted magnetic resonance imaging in acute stroke. Material/Methods: Computerized tomography was performed in the group of 125 patients with clinical diagnosis of stroke within 12 hours from the onset of symptoms. Follow-up CT was done within 7 days to confirm the presence of ischemic changes. Early abnormalities found on CT scans included: hypoattenuation of lentiform nucleus (ALN), loss of insular ribbon (LIR), hemispheric sulcus effacement (HES) and hyperdense middle cerebral artery sign (HMCAS). These findings were detected in 57.6% of patients examined with CT. Sensitivity of early CT increased from 54,5% within 3 hours after onset of symptoms to 90% in the studies performed within 6 and 12 hours from the onset. Results: Magnetic resonance imaging with diffusion weighted spin echo was performed in 53 patients, who had negative CT examination for acute ischemic changes. Diffusion weighted imaging showed acute ischemic lesions in 92.5% of patients. Findings included one focal lesion in 54.7% patients, 26.4% patients had changes in two cerebral lobes and 11.3% patients had diffuse lesions in three cerebral lobes and basal ganglia. Conclusions: Computerized tomography proved to be a sensitive modality in imaging of middle cerebral artery ischemic lesions. Diffusion weighted imaging in low field MR system is a fast and useful technique for detecting ischemic lesions in early stroke in cases of negative CT findings

Wpływ przeszczepu wątroby na zmiany w rezonansie magnetycznym mózgu w chorobie Wilsona – opis przypadku

The authors present a case report of a 28-year-old patient with hepatic, but no neurological, signs of Wilson disease, with pathological changes in both the globi pallidi and caudate found with routine brain magnetic resonance imaging (MRI). The patient was recommended for liver transplantation by hepatologists, and during the two years of observation after liver transplantation, MRI brain abnormalities due to Wilson disease completely regressed. On the basis of this case, the authors present an argument for the prognostic significance of brain MRI in Wilson disease as well as current recommendations concerning liver transplantation in Wilson disease.Autorzy przedstawiają przypadek 28-letniego pacjenta z wyłącznie wątrobowymi objawami choroby Wilsona, bez objawów neurologicznych, oraz ze zmianami w obrębie gałek bladych i skorup w rezonansie magnetycznym mózgu (RM). Chory został zakwalifikowany przez hepatologów do przeszczepienia wątroby. Po dwóch latach od operacji stwierdzono całkowite ustąpienie zmian patologicznych w obrazie RM. Na przykładzie opisanego przypadku omówiono znaczenie rokownicze badań RM mózgu w chorobie Wilsona oraz aktualne zalecenia dotyczące przeszczepiania wątroby w leczeniu tej choroby

MRI brain findings in ephedrone encephalopathy associated with manganese abuse : single-center perspective

Background: Manganese (Mn) is a well-known toxic agent causing symptoms of parkinsonism in employees of certain branches of industry. Home production of a psychostimulant ephedrone (methcathinone), involving the use of potassium permanganate, became a new cause of intoxications in Poland. Case Report: This article presents clinical symptoms, initial brain MRI findings and characteristics of changes observed in follow-up examinations in 4 patients with manganese intoxication associated with intravenous administration of ephedrone. All patients in our case series presented symptoms of parkinsonism. T1-WI MRI revealed high intensity signal in globi pallidi in all patients; hyperintense lesions in midbrain were observed in three patients, while lesions located in cerebellar hemispheres and pituitary gland in just one patient. The reduction of signal intensity in the affected brain structures was observed in follow-up studies, with no significant improvement in clinical symptoms. Conclusions: Brain MRI is helpful in the assessment of distribution as well as dynamics of changes in ephedrone encephalopathy. Regression of signal intensity changes visible in brain MRI is not associated with clinical condition improvement. Although brain MRI findings are not characteristic for ephedrone encephalopathy, they may contribute to diagnosing this condition

Clinical validity of MR based program for analysis of fluid/brain index of posterior cranial fossa structures in patients with spinocerebellar ataxia

Background: Spinocerebellar ataxia type 1 (SCA1) and type 2 (SCA2) belong to the group of neurodegenerative disorders of autosomal dominant inheritance, genetically and clinically heterogeneous, caused by CAG trinucleotide repeat expansion, which leads to productions of protein carrying the abnormal polyglutamine chain (polyQ). Molecular abnormalities cause degenerative changes - atrophy of posterior cranial fossa structures. The clinical symptoms typical of this disorder include progressive gait and limb ataxia, dysarthria, occulomotor disturbances, pyramidal tract and peripheral nerves involvement. The aim of the study is to evaluate the usefulness of a computer program prepared in our department for volumetric measurements of posterior cranial fossa structures (the pons, vermis and cerebellar hemispheres) in a group of SCA patients. Material/Methods: MR examinations of 22 patients suffering from SCA were used to calculate the value of fluid/brain index of posterior cranial fossa structures and compared with the results of group of 10 healthy volunteers. The degree of atrophy of posterior cranial fossa structures can be objectively evaluated by special volumetric measurements. Results: We found fluid/brain index (FBI) of posterior cranial fossa structures in group of SCA patients to vary from 0.1411 to 0.3929 (mean 0.2456 SD±0.601). Conclusions: 1. MR-based calculation of fluid/brain index of posterior fossa structures is a valuable tool for morphological assessment of SCA-related changes in brain structures. 2. The presented software enables objective evaluation of the course and stage of posterior fossa structures atrophy. 3. Our self-made computer program to calculate the fluid/brain index of posterior cranial fossa structures is easy to use on a personal computer - it is a good tool in everyday radiological practice