Consistent depiction of the acidic ischemic lesion with APT MRI—Dual RF power evaluation of pH‐sensitive image in acute stroke

Purpose: Delay in identification and treatment of hemorrhagic stroke can result in severe disability and death. Differentiation of acute stroke is essential to successful emergency treatment and patient outcome. A head CT scan is the gold standard for identifying hemorrhagic stroke. This pilot study evaluates utilization of a handheld infra-red screening device for possible detection of hemorrhagic stroke in the pre-hospital setting. Methods: The study involved collaboration with regional emergency medical services. Device education and competencies were completed by all paramedics. A stroke assessment form was utilized in conjunction with the device on all patients experiencing signs and symptoms of acute stroke. Data obtained by the device was compared to the initial head CT scan obtained in the hospital Emergency Trauma Center. Results: A total of 46 patients were enrolled in this pilot study. The device and head CT data were evaluated on ability to detect the presence of hemorrhagic stroke. Of the 46 patients, 7 patients were admitted with hemorrhagic stroke after positive head CT results. Out of these 7 patients, 5 had positive device results. There were 14 patients admitted with a diagnosis of acute ischemic stroke, 8 of these patients had false positive device results. Stroke mimic enrollment included 25 patients, 15 with false positive device results. Conclusion: The handheld infra-red screening device detected all hemorrhagic stroke cases that were within the detection abilities of the system. Large vessel ischemic strokes scanned by EMS demonstrated increased blood flow and on the opposite side of the ischemic lesion. Stroke mimics included cardiac abnormality, seizure and dehydration. Several challenges in the use of the device are noted. The 2-3 minutes it took EMS to scan correctly, was too long for scanning stroke patients, decreasing this measurement time appeared to contribute to false positive results. Measurements performed during fast ambulance transport appeared to also cause false positive readings. Difficulty to achieve reliable measurement was also noted with combative and epileptic patients. EMS feedback was provided to the device manufacturer. The researchers recommend continued research to support this effort.

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Abstract 3745: General Versus Local Anesthesia In Endovascular Therapy For Acute Ischemic Stroke (ais) In Anterior Vessel Occlusions. A Case-control Study

Stroke ◽

10.1161/str.43.suppl_1.a3745 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Meritxell Gomis ◽

Marc Ribo ◽

MÓnica Millán ◽

Marta Rubiera ◽

Natalia Pérez de la Ossa ◽

...

Keyword(s):

Acute Stroke ◽

Endovascular Therapy ◽

Case Control Study ◽

Functional Dependence ◽

Case Control ◽

Stroke Therapy ◽

Ischemic Lesion ◽

Poor Outcome ◽

Control Study ◽

Acute Stroke Therapy

Background and purpose Recent evidence supports the shift from general (GA) to local (LA) anesthesia in endovascular acute stroke therapy. However, the optimal modality of anesthesia during this type of procedure has not been established in controlled studies. We compared safety and efficacy on clinical and imaging outcomes between these two sedation modalities in a case-control study. Methods Retrospective observational case-control study of patients with AIS and anterior arterial occlusions treated with endovascular therapy (EVT) according to similar protocols (direct IA, bridging IV t-PA/IA and failed or contraindicated IV t-PA) in two tertiary academic stroke centers that used two different sedation modalities as standard of care, the first under GA and the second under LA. From 298 patients consecutively registered between 2008 and 2011, a total of 206 were classified in two groups (GA, n=103; LA, n=103) matched by age and baseline NIHSS, blind to outcome variables. Outcome variables were ischemic lesion volume and symptomatic ICH at 24-36h, functional dependence (Rankin >3) and mortality at 3 months. Logistic regression and interaction analyses were used to evaluate the effect of GA/LA on outcome variables. Results GA and LA groups were comparable regarding TOAST classification, occlusion site (for GA/LA n= 24/27 ICA or TICA; 51/50 MCA-1; 12/10 MCA-2; 16/16 tandem ICA-MCA), prior IV t-PA use (n= 54/61) and preprocedure TICI score. However, the time from onset to groin puncture (TOGP) was longer in GA patients (median hours, 5.0/3.6) who were more frequently treated following MRI mismatch criteria (n= 55/7). At 24-36 hours, median infarct volume was 25/56 cc (p=0.02) and sICH was found in 10/7 patients (p=NS). Ninety-four patients in each group had completed the 3 months follow-up. Functional dependence was found in 58/55 patients and mortality in 23/33 (p=NS). The adjusted OR of GA for poor functional outcome was 1.83 (95%CI, 0.84-3.97). There was a GA*TOGP interaction on poor outcome: in the TOGP <5 hours group (n=125) the OR of GA was 2.57 (1.02-6.47) whereas it was 0.18 (0.02-1.67) in the TOGP >5 h group (n=57). Conclusions This case-control study shows that endovascular acute stroke therapy under GA results in comparable clinical and radiographic outcomes than under LA. However, GA seems to be associated with poor outcome in patients treated in less than 5 hours.

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Auditory Hallucinations in Acute Stroke

Behavioural Neurology ◽

10.1155/2005/641953 ◽

2005 ◽

Vol 16 (4) ◽

pp. 211-216 ◽

Cited By ~ 17

Author(s):

Yair Lampl ◽

Mordechai Lorberboym ◽

Ronit Gilad ◽

Mona Boaz ◽

Menachem Sadeh

Keyword(s):

Acute Stroke ◽

Cross Sectional Study ◽

Auditory Hallucinations ◽

Stroke Patients ◽

Cross Sectional ◽

Ischemic Lesion ◽

Cortical Stroke ◽

The Right ◽

The Brain

Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.

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Elevation of plasma oxidized LDL in acute stroke patients is associated with ischemic lesion depicted by DWI and predictive of infarct enlargement

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9591524.0123 ◽

2005 ◽

Vol 25 (1_suppl) ◽

pp. S123-S123

Author(s):

Masaaki Uno ◽

Keiko Kitazato ◽

Atsuhiko Suzue ◽

Kyoko Nishi ◽

Shinji Nagahiro

Keyword(s):

Acute Stroke ◽

Oxidized Ldl ◽

Stroke Patients ◽

Ischemic Lesion

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Abstract TP49: Irreversible Ischemic Lesion Characterization: Does CBV_ASPECTS Add to CT_ASPECTS?

Stroke ◽

10.1161/str.47.suppl_1.tp49 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Marina Padroni ◽

Pilar Coscojuela ◽

Sandra Boned ◽

Marc Ribó ◽

Jordi Cabero ◽

...

Keyword(s):

Acute Stroke ◽

Symptom Onset ◽

Cerebral Blood Volume ◽

Ct Perfusion ◽

Infarct Volume ◽

Relevant Information ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Anterior Circulation ◽

Ischemic Lesion

Introduction: The best technique for selecting acute stroke patients for reperfusion therapies is not defined yet. ASPECTS is a useful score for assessing the extent of early ischemic signs in the anterior circulation on non-contrast CT (CT). Cerebral blood volume (CBV) on CT perfusion (CTP) defines the core lesion assumed to be irreversibly damaged. Whether CBV provides additional information over CT in the initial ASPECTS assessment is unknown. We aim to explore the advantages of CBV_ASPECTS over CT_ASPECTS in the prediction of final infarct volume. Methods: Consecutive patients with middle cerebral or internal carotid artery occlusion who underwent endovascular reperfusion treatment according to initial CT_ASPECTS≥7 were studied. CBV_ASPECTS was assessed blindly later-on. Recanalization was defined as TICI2b3. Final infarct volumes were measured on follow-up imaging. We defined an irrelevant ASPECTS difference (IAD) as: CT_ASPECTS - CBV_ASPECTS≤1. Results: Sixty-five patients, mean age 67±14, median NIHSS:16(10-20) were studied. Recanalization rate was: 78.5%. Median CT_ASPECTS was 9(8-10), and CBV_ASPECTS 8(8-10). Mean time from symptom onset to CT was 219±143 min. 50 patients (76.9%) showed an IAD. The ASPECTS difference was inversely correlated to the time from symptom onset to CT (r:-0.36, p<0.01). A ROC curve defined 120 minutes as the best cut-off time point after which the ASPECTS difference becomes irrelevant. The rate of IAD was significantly higher after 120 minutes (89.5% Vs 37.5; p<0.01). CBV_ASPECTS but not CT_ASPECTS correlated to the final infarct (r:-0.33, p<0.01). However, if CT was done >2 hours after symptom onset, then CT_ASPECTS was correlated to final infarct (r:-0.39, p=0.01). No other variables were associated with CT-CBV_ASPECTS difference. Conclusions: In acute stroke patient CBV_ASPECTS correlates with final infarct volume. However, when CT is performed after 120 minutes from symptoms onset CBV_ASPECTS does not add relevant information to CT_ASPECTS.

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Clinical Usefulness of Technetium-99m HMPAO SPECT Imaging to Map the Ischemic Lesion in Acute Stroke: A Reevaluation

Cerebrovascular Diseases ◽

10.1159/000108495 ◽

1994 ◽

Vol 4 (4) ◽

pp. 280-286 ◽

Cited By ~ 3

Author(s):

Patrice Laloux ◽

Michel Doat ◽

Christine Brichant ◽

Francisca Cauwe ◽

Jacques Jamart ◽

...

Keyword(s):

Acute Stroke ◽

Spect Imaging ◽

Clinical Usefulness ◽

Ischemic Lesion ◽

Technetium 99M ◽

Hmpao Spect

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Elevated Circulating Endothelial Microparticles in Acute Stroke Patients: A Correlation with Brain Lesion Volume and Outcome.

Blood ◽

10.1182/blood.v104.11.3504.3504 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3504-3504 ◽

Cited By ~ 3

Author(s):

Jan Simak ◽

Monique P. Gelderman ◽

Hua Yu ◽

Violet Wright ◽

Noah Alberts-Grill ◽

...

Keyword(s):

Acute Stroke ◽

Hospital Discharge ◽

Vascular Injury ◽

Brain Lesion ◽

Lesion Volume ◽

Stroke Patients ◽

Disability Score ◽

Ischemic Lesion ◽

Blood Samples

Abstract Elevated endothelial cell membrane microparticles (EC MP) in blood have been demonstrated in various diseases with a vascular injury component. The aim of this study was to investigate if circulating EC MP show a relationship with outcome after acute stroke and with the ischemic brain lesion volume measured by magnetic resonance diffusion-weighted imaging (DWI). We analyzed EC MP in the blood of 42 acute stroke patients (AS): 20 patients with National Institutes of Health Stroke Scale (NIHSS) scores < 5 were classified as mild stroke (MS) (median NIHSS= 2; 25th–75th%: 0–2), while the other 22 patients with NIHSS ≥5 (NIHSS=12; 6–21) were classified as moderate to severe stroke (SS). Peripheral venous blood samples were collected at a median time of 36 hours (18–52) after the onset of clinical symptoms. The patients outcome was based on the Rankin disability score at the time of hospital discharge. Blood samples of 23 age matched control volunteers (CTRL) were used for comparison. EC MP analysis used a three-color flow cytometry assay (Simak et al, British J Haematol125, 804–813, 2004). EC MP were identified by antibodies to EC antigen CD105 (endoglin) and the highly specific CD144 (VE-cadherin). Platelet, white, and red blood cell MP were identified using cell specific antibodies to CD41, CD45, and CD235a, respectively. Plasma counts of CD105+CD41−CD45- EC MP were elevated in SS (median: 840/μL; 25th–75th%: 565–1079/μL) as compared to CTRL (415/μL; 201–624/μL; p=0.014). Moreover, CD105+CD144+ EC MP were elevated in SS (261/μL; 137–433/μL) when compared to MS (154/μL; 99–182/μL; p=0.031) or CTRL group (140/μL; 79–247/μL; p=0.031). Interestingly, CD105+CD41−CD45- EC MP, but not CD105+CD144+ EC MP, exhibited a significant correlation (p=0.005; r=0.45) with DWI brain lesion volume in AS group. However, CD105+CD144+ EC MP in the admission samples highly correlated (p=0.0007; r=0.54) with the Rankin disability score in the AS group at hospital discharge, while correlation of CD105+CD41−CD45- EC MP with the Rankin score was not as significant (p=0.007; r=0.44). We further analyzed 12 MS and 12 SS follow-up samples collected at a median period of 10 days (7–14) after the first sampling. Surprisingly, in SS follow-up samples, CD105+ EC MP populations decreased, while CD144+CD105−CD41- EC MP significantly increased, as compared to the samples at admission. In conclusion, the SS patient group had elevated different phenotypes of EC MP in the plasma samples at admission when compared to MS or CTRL groups. This is likely a reflection of the severity of ischemic-reperfusion injury of the brain vasculature. Elevated endoglin-positive EC MP were associated with brain ischemic lesion volume, whereas EC MP positive for both endoglin and VE-cadherin in the admission samples showed highly significant correlation with the patients disability outcome. The increased VE-cadherin-positive EC MP in follow-up samples may reflect a continuing endothelial injury in SS patients. Analysis of different phenotypes of EC MP in peripheral blood of stroke patients may be indicative of volume, character and severity of brain vascular injury and could be of diagnostic and prognostic use.

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