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  • 1
    ISSN: 1432-1459
    Keywords: Lacunar infarct ; White matter lesions ; Computed tomography ; Magnetic resonance imaging ; Cognition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Forty-four patients (mean age 66, SD 8 years) with either clinical evidence of a focal lacunar syndrome (n=36) or with disorders of memory or gait (n=8) in the presence of a lacunar infarct on CT were studied for cognitive functioning and for the presence of white matter lesions on MRI. MR images were assessed by a neurologist and a neuro-radiologist blinded to the clinical data. Thirty-six patients had one or more lacunar infarets on CT or MRI (in the thalamus in 5, in the caudate nucleus in 3 and in the internal capsule or corona radiata in the remaining patients). Twelve patients had multiple infarcts. Severe lesions of the white matter were found in 13 patients, mild to moderate lesions in 20 patients. Scores on Digit Span, Digit Symbol and delayed recall of the 15-Words test were significantly lower in the group with severe lesions, whilst there was a trend in the same direction for the Cognitive part of the Cambridge Examination of Mental Disorders in the Elderly, the Trailmaking B, Stroop colour interference test and the delayed visual reproduction of the Wechsler Memory Scale. These findings suggest that diffuse lesions of the white matter are an independent factor in the pathogenesis of intellectual dysfunction, also in patients with lacunar infarcts, but a truly independent analysis is difficult because the most severe involvement of the white matter tended to be associated with the largest number of lacunar infarcts.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1084
    Keywords: Key words: Perfusion – Diffusion – Infarction – Ischemia – MR imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The aim of this study was to evaluate the differences in cerebral perfusion seen on mean transit time (MTT) and cerebral blood volume (CBV) maps and to assess the subsequent prognostic value of the MTT–DWI (diffusion-weighted MRI) and CBV–DWI mismatch in the first three days of stroke on lesion enlargement and clinical outcome. In 38 patients, imaged 1–46 h after onset of symptoms, lesion volumes on proton-density (PD)-weighted MRI, DWI and PWI (both MTT and CBV maps) were compared with lesion volumes on follow-up PD-weighted scans, and to clinical outcome (National Institutes of Health Stroke Scale, Barthel index, and Rankin scale). The MTT-CBV, MTT–DWI and CBV–DWI mismatches were compared with change in lesion volume between initial and follow-up PD-weighted scans. Lesion volume on both DWI and PWI correlated significantly with clinical outcome parameters (p 〈 0.001) with strongest correlation for lesion volume on CBV. Perfusion–diffusion mismatches were found for both CBV and MTT and correlated significantly with lesion enlargement on PD-weighted imaging with strongest correlation for the CBV–DWI mismatch. The CBV–DWI mismatch has the highest accuracy in predicting lesion size on follow-up imaging and in predicting clinical outcome. Lesion volume measurements on CBV maps have a higher specificity than on PD-weighted, MTT or DWI images in predicting clinical follow-up imaging and in predicting clinical outcome.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1459
    Keywords: Migraine ; Cerebral ischaemia ; Cerebrovascular disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There have been few reports concerning the characteristics of cerebral infarction associated with migraine (CIAM), and especially about the subsequent fate of these patients. We studied 14 patients (9 female) with CIAM. In all these patients the onset of cerebral infarction was accompanied by a unilateral throbbing headache, in 8 also with a gradual build-up of neurological deficits. No other cause of cerebral infarction could be found in these patients. Twelve patients had had previous attacks of migraine, with auras in 6. The nature of the neurological deficit was similar to previous auras in only 3 of these patients. The 2 patients without a history of migraine both developed migraine attacks afterwards. During the same period we also studied 14 patients (8 female) with a cerebral infarct of unknown origin (CIUO). The infarct involved the occipital lobe in 11 of the 14 patients with CIAM, whereas this occurred in 4 patients with CIUO [relative risk (RR): 2.8; 95% confidence interval (CI): 1.2–6.6]. Patients with CIAM had risk factors for atherosclerosis significantly less often than patients with CIUO (RR: 0.1; 95% CI: 0.02–0.9). The functional outcome of patients with CIAM was better than in patients with CIUO: all 14 patients with CIAM were independent in their daily activities, compared with 9 patients with CIUO (RR: 1.6; 95% CI: 1.1–2.3). No patient in either group had a recurrent stroke during a median follow-up period of 5.8 years. In conclusion. CIAM is a stroke entity causing mostly infarcts in the occipital lobe; vascular risk factors are uncommon and prognosis is generally good.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1920
    Keywords: Cerebral infarction ; Lacunar infarction ; Stroke ; Computed tomographic scan ; Observers ; Agreement ; Bias
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Interobserver agreement in assessing brain CT-scans is, in general, high. The extent, however, to which such agreement is caused by bias through knowledge of other clinical details remains uncertain. The hypothesis that observers are somehow prejudiced before assessing ambiguous CT-scans in this particular situation was tested. Sixteen neurologists and 16 radiologists volunteered to interpret two ambiguous brain CT-scans, with regard to the presence or absence of a lacunar infarct in the region of the internal capsule. The scans were accompanied by “patient” information that was or was not suggestive of a stroke. These scans were camouflaged by a variety of other scans, to be assessed in the same way, to mask the purpose of the study. It was assumed that the observers, in their assessments of the scans, would somehow let their ratings of the likelihood of a lacunar infarction in or near the internal capsule be subject to the accompanying information. Results showed lower ratings produced by neurologists (i. e., less likelihood of an infarction) than by radiologists in the majority of all assessments, but no bias by the accompanying information.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 31 (1989), S. 316-319 
    ISSN: 1432-1920
    Keywords: Lacunar infarction ; Computerized tomographic study ; Cerebrovascular disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a prospective study of 78 patients presenting with recent clinical features of a supratentorially located lacunar infarct (LI), serial CT-scanning with contiguous 6, 5 or 3 mm slices was carried out. LI was found in 59 patients (76%; 95% confidence limits 65–85%). Lesions other than lacunar infarcts were found in 5 patients (6%; 95% confidence limits 2–14%); in only 14 patients could no abnormalities be detected (18%; 95% confidence limits 10–28%). There was no relationship between the detection rate on CT on the one hand and the type of lacunar syndrome, the number of previous TIA's, and the duration or severity of the neurological deficit on the other. A new protocol of CT-scanning for screening LI is advocated for situations where no MRI facilities are available or no patients cooperation can be obtained.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 35 (1993), S. 567-572 
    ISSN: 1432-1920
    Keywords: Mycotic infection ; Encephalitis ; Grey matter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In mycotic infections of the brain three patterns of abnormality may be observed: meningitis, granuloma, and encephalitis. The first two, consisting of diffuse meningeal enhancement and mass lesion respectively, can easily be visualized by CT or MRI, but are nonspecific. The third pattern has been described histopathologically; as the clinical picture is nonspecific and the diagnosis is often unsuspected, especially in immunocompetent patients, acquaintance with the characteristic CT and MRI patterns of mycotic encephalitis may help in establishing the correct diagnosis, with important therapeutic consequences.
    Type of Medium: Electronic Resource
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