The magnetic resonance imaging ‘spot’ sign: a sign of imminent intracranial hemorrhage?

Abstract Objective: To determine whether preterm infants diagnosed with intracranial hemorrhage (by transfontanellar ultrasound) at birth have cerebral lesions that are detectable by magnetic resonance imaging (MRI) upon reaching school age. Materials and Methods: MRI scans of the brain were obtained in 22 school-age children. Fifteen had presented intracranial hemorrhage at birth, and seven had not. We calculated the odds ratio (OR) for the occurrence of brain alterations detectable by MRI and the kappa index for discrepancies among the radiological reports. Results: The children without previous intracranial hemorrhage presented normal MRI findings. Of the 15 children with previous intracranial hemorrhage, 6 (40%) presented brain alterations on MRI: isolated ventricular alteration (dilation and asymmetry), in 2 (13.3%); and ventricular asymmetry accompanied by parenchymal lesion, in 4 (26.7%). The nine remaining children with previous intracranial hemorrhage (60%) presented normal MRI findings. The children with previous intracranial hemorrhage were more likely to present ventricular alteration (OR = 7.8) and parenchymal lesions (OR = 5.4). Conclusion: Ventricular and parenchymal brain alterations detected by MRI suggest isolated morphologic alterations that do not result in neurological impairment detectable on physical examination in school-age children.

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Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging

Stroke ◽

10.1161/strokeaha.115.011570 ◽

2016 ◽

Vol 47 (2) ◽

pp. 417-423 ◽

Cited By ~ 20

Author(s):

Katharina A. Schindlbeck ◽

Anna Santaella ◽

Ivana Galinovic ◽

Thomas Krause ◽

Andrea Rocco ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Intracerebral Hemorrhage ◽

Resonance Imaging ◽

Spot Sign ◽

Weighted Magnetic Resonance Imaging ◽

Acute Intracerebral Hemorrhage

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Biopsy of the Superficial Cortex

Neurosurgery ◽

10.1227/01.neu.0000430310.63702.3e ◽

2013 ◽

Vol 73 (2) ◽

pp. 224-232 ◽

Cited By ~ 3

Author(s):

Ammar H. Hawasli ◽

Robert T. Buckley ◽

Feng Gao ◽

David D. Limbrick ◽

Matthew D. Smyth ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Intracranial Hemorrhage ◽

Neurological Diseases ◽

Older Age ◽

Resonance Imaging ◽

Clinical Predictors ◽

Imaging Characteristics ◽

Diagnostic Biopsy ◽

Preoperative Predictors

Abstract BACKGROUND: Brain biopsies of superficial cortex are performed for diagnosis of neurological diseases, but preoperative predictors of successful diagnosis and risks are lacking. OBJECTIVE: We evaluated effectiveness and outcomes of superficial cortical biopsies and determined preoperative predictors of diagnosis, outcomes, morbidities, and mortality. METHODS: A single-institution retrospective analysis of 170 patients who underwent open brain biopsies of superficial cortex was performed. Clinical predictors of effectiveness and outcomes were determined using univariate/multivariate analyses and a system for risk-benefit stratification was created and tested. RESULTS: Brain biopsies led to successful diagnosis in 122 of 170 (71.8%) and affected management in 97 of 170 (57.1%) cases. Factors increasing the odds of diagnostic pathology included age older than 45 years (odds ratio [OR]: 2.67, 95% confidence interval [CI]: 1.34-5.27, P < .01), previous cancer diagnosis (OR: 3.64, 95% CI: 1.69-7.85, P < .001), focal (OR: 3.90, 95% CI: 1.91-8.00, P < .001) and enhancing (OR: 5.03, 95% CI: 2.41-10.52, P < .001) lesions on magnetic resonance imaging, biopsy of specific lesions on magnetic resonance imaging (OR: 9.34, 95% CI: 4.29-20.33, P < .001), and use of intraoperative navigation (OR: 6.59, 95% CI: 3.04-14.28, P < .001). Brain biopsies led to symptomatic intracranial hemorrhage, seizures, other significant morbidities, and perioperative mortality in 12.4%, 16.2%, 37.1%, and 8% of cases, respectively. Risk of postoperative intracranial hemorrhage was increased by a history of aspirin use (OR: 2.51, 95% CI: 1.23-5.28, P < .05) and age older than 60 years (OR: 2.66, 95% CI: 1.36-5.18, P < .01). CONCLUSION: Effectiveness and risk of morbidity/mortality can be estimated preoperatively for patients undergoing open brain biopsies of the superficial cortex. Older age and specific imaging characteristics increase the odds of diagnostic biopsy. Conversely, older age and aspirin use increases the risk of postoperative complications.

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Endovascular Administration after Intravenous Infusion of Thrombolytic Agents for the Treatment of Patients with Acute Ischemic Strokes

Neurosurgery ◽

10.1097/00006123-200202000-00005 ◽

2002 ◽

Vol 50 (2) ◽

pp. 251-260 ◽

Cited By ~ 9

Author(s):

Jose I. Suarez ◽

Osama O. Zaidat ◽

Jeffrey L. Sunshine ◽

Robert Tarr ◽

Warren R. Selman ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Intracranial Hemorrhage ◽

Recombinant Tissue Plasminogen Activator ◽

Resonance Imaging ◽

Vessel Occlusion ◽

Perfusion Weighted Imaging ◽

Tissue Plasminogen

ABSTRACT OBJECTIVE To determine the feasibility of combined intravenous and intra-arterial thrombolytic therapy for acute ischemic strokes and to evaluate its associated risks, using magnetic resonance imaging as a triage tool. Intravenous treatment followed by intra-arterial infusion may increase the rate of recanalization and lead to better clinical results, with reduced frequency of intracranial hemorrhage. METHODS Our Brain Attack Team evaluated patients who presented within 3 hours after symptom onset. Patients who did not demonstrate improvement and exhibited no evidence of intracranial hemorrhage on head computed tomographic scans were treated with intravenously administered recombinant tissue plasminogen activator (0.6 mg/kg) and underwent emergency magnetic resonance imaging of the head. T2-weighted turbo-gradient and spin echo and echo-planar diffusion- and perfusion-weighted imaging scans were obtained. Patients with evidence of imaging abnormalities indicating acute cortical infarction underwent cerebral angiography. After determination of vessel occlusion, intra-arterially administered urokinase (up to 750,000 units) or intra-arterially administered recombinant tissue plasminogen activator (maximal dose, 0.3 mg/kg) was used to achieve recanalization. RESULTS We treated 45 patients with this protocol. The mean age was 67 ± 13 years, and 58% of the patients were women. There was a significant improvement in National Institutes of Health Stroke Scale scores after treatment. There was good correlation between abnormal perfusion-weighted imaging findings and cerebral angiographic findings (complete vessel occlusion). The incidence of symptomatic intracranial hemorrhage was 4.4% in this cohort. Seven patients died in the hospital, and the majority of survivors (77%) experienced good outcomes (Barthel index of ≥95) 3 months after treatment. CONCLUSION Our data demonstrate that this protocol is feasible and that combined intravenous and intra-arterial thrombolysis to treat acute ischemic strokes is sufficiently safe to warrant further evaluation.

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