Abstract TP44: Quantifying Edema in Acute Stroke

Introduction: The Acute Stroke Imaging Roadmap III identifies structural distortion due to vasogenic edema and hemorrhage as a research priority for defining final infarction. Non-linear registration (NLR) of a follow up scan to an undistorted presenting scan could correct for distortions due to edema, hemorrhage or atrophy, achieving this goal. In addition, the difference between the volume of infarction following NLR and the volume following a rigid body registration (RBR) reflects the degree of anatomical distortion. In this study we evaluate this technique to correct for subacute edema at different timepoints, and generate a metric to quantify brain swelling at these times. We determine whether early edema at 24 hours predicts edema at 1 week. Methods: Patients with non-lacunar ischemic stroke were recruited into a MRI study. Patients had structural T1-weighted, T2-weighted FLAIR and diffusion-weighted imaging (DWI, b=1000/0) at presentation, 24hrs, 1wk and 1mo. Infarction was defined manually at 24hrs using DWI, and at 1wk and 1mo using FLAIR image by 2 raters. To quantify edema, both NLR warps and RBR matrices were generated between the T1 images at each timepoint to the presenting T1 scan. Infarct masks were transformed to presenting image space using RBR and NLR, and the relative difference in volumes used to quantify the Edema Metric (EM). Results: 34 patients were recruited into the study. NLR corrected for distortions due to edema and hemorrhagic transformation at the 24hr and 1wk timepoints. The EM at 24 hours, 1 week and 1 month were 17.7% (p=0.009), 26.5% (p=0.02), and 7.1% (p=0.05) respectively for the manually defined infarct masks. EM at 24 hours predicted edema at 1 week (r 2 =37%, p=0.009), but not at 1 month (r 2 =3%, p=0.6). Conclusions: NLR provides an opportunity to correct for edema at subacute timepoints and by comparing infarct volumes to those following RBR provides a measure of edema. The EM quantifies the contribution of edema at 24hrs and 1wk, and potentially allows the selection of patients at 24hrs who are likely to develop significant swelling at 1 week. The EM may also be useful in stroke trials to quantify the effect sizes of treatments aimed at minimizing edema in stroke.

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Age-dependency in mortality of Finnish family caregivers: a nationwide register-based study

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1191 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T M Mikkola ◽

H Kautiainen ◽

M Mänty ◽

M B von Bonsdorff ◽

T Kröger ◽

...

Keyword(s):

General Population ◽

Family Caregivers ◽

Family Caregiver ◽

Causes Of Death ◽

Lower Mortality ◽

All Cause Mortality ◽

The Difference ◽

Caregiver Role ◽

Selection Of

Abstract Purpose Mortality appears to be lower in family caregivers than in the general population. However, there is lack of knowledge whether the difference in mortality between family caregivers and the general population is dependent on age. The purpose of this study was to analyze all-cause mortality in relation to age in family caregivers and to study their cause-specific mortality using data from multiple Finnish national registers. Methods The data included all individuals, who received family caregiver's allowance in Finland in 2012 (n = 42 256, mean age 67 years, 71% women) and a control population matched for age, sex, and municipality of residence (n = 83 618). Information on dates and causes of death between 2012 and 2017 were obtained from the Finnish Causes of Death Register. Flexible parametric survival modeling and competing risk regression adjusted for socioeconomic status were used. Results The total follow-up time was 717 877 person-years. Family caregivers had lower all-cause mortality than the controls over the follow-up (8.1% vs. 11.6%) both among women (hazard ratio [HR]: 0.64, 95% CI: 0.61-0.68) and men (HR: 0.73, 95% CI: 0.70-0.77). Younger adult caregivers had equal or only slightly lower mortality than their controls, but after age 60, the difference increased markedly resulting in over 10% lower mortality in favor of the caregivers in the oldest age groups. Caregivers had lower mortality for all the causes of death studied, namely cardiovascular, cancer, neurological, external, respiratory, gastrointestinal and dementia than the controls. Of these, the lowest was the risk for dementia (subhazard ratio=0.29, 95%CI: 0.25-0.34). Conclusions Older family caregivers have lower mortality than the age-matched controls from the general population while younger caregivers have similar mortality to their peers. This age-dependent advantage in mortality is likely to reflect selection of healthier individuals into the family caregiver role. Key messages The difference in mortality between family caregivers and the age-matched general population varies considerably with age. Advantage in mortality observed in family caregiver studies is likely to reflect the selection of healthier individuals into the caregiver role, which underestimates the adverse effects of caregiving.

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Tumefactive Multiple Sclerosis Clinically Mimicking Acute Stroke and Lesional Migration Along the Biopsy Tract: A Case Report

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v19i2.33 ◽

2019 ◽

Vol 19 (2) ◽

pp. 148-153

Author(s):

Oranan Tritanon ◽

Arunee Singhsnaeh ◽

Jiraporn Laothamatus ◽

Atthaporn Boongird ◽

Disya Ratanakorn ◽

...

Keyword(s):

Multiple Sclerosis ◽

Acute Stroke ◽

Demyelinating Disease ◽

Internal Capsule ◽

Chronic Inflammatory Cell ◽

Left Frontal Lobe ◽

Lentiform Nucleus ◽

Mri Study ◽

Tumefactive Multiple Sclerosis

Tumefactive multiple sclerosis is a form of demyelinating disease which patient can present with acute stroke. We reported a case of a 49-year-old woman with well controlled hypertension, who presented with right hemiplegia 15 hours prior to admission. The initial diagnosis of acute stroke was made. Emergency computed tomography showed hypodense lesion at the left lentiform nucleus and posterior limb of the left internal capsule. The magnetic resonance imaging (MRI) study showed hyperintense FLAIR lesion in the left lentiform nucleus, left internal capsule, left thalamus, and periventricular area of the left frontoparietal region, some areas of restricted diffusion and inhomogeneous enhancement. The MR spectroscopy (MRS) of the lesion showed increased choline peak, decreased creatine and NAA peaks, and maximal choline to creatine ratio 2.25. Her symptoms deteriorated with progressive headache and motor aphasia. The follow up MRI showed extension of the inhomogeneous enhancing lesion along the biopsy tract at the left frontal lobe with the enhancing and MR spectra pattern similar to the lesion. The craniotomy with left frontal lesion excision included the mass and the biopsy tract was done. The lesion showed acute and chronic inflammatory cell infiltration with macrophages, necrotic tissue and reactive gliosis. The further pathological worked up demonstrated foci of demyelination with relative axonal preservation, numerous CD68+ macrophages with intracyto-plasmic Luxol fast blue(+) myelin debris. Perivascular and parenchymal CD3+ T-cells were identified, especially in demyelinating foci. These findings supported the diagnosis of tumefactive multiple sclerosis. Her conditions were improved after treating with pulse methylprednisolone and intravenous immunoglobulin (IVIG). Follow up MRI study 4 months after treatment revealed almost resolution of the preexisting inhomogeneous enhancing lesion.

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Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/strokeaha.119.025898 ◽

2019 ◽

Vol 50 (12) ◽

pp. 3569-3577 ◽

Cited By ~ 9

Author(s):

David J. Lin ◽

Alison M. Cloutier ◽

Kimberly S. Erler ◽

Jessica M. Cassidy ◽

Samuel B. Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Area Under The Curve ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Stroke Imaging ◽

Recovery Potential

Background and Purpose— Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods— Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results— N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions— Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery.

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Brain Abscess Masquerading as Brain Infarction

Brain Sciences ◽

10.3390/brainsci10070440 ◽

2020 ◽

Vol 10 (7) ◽

pp. 440

Author(s):

Da-Eun Jeong ◽

Jun Lee

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Vasogenic Edema ◽

Brain Infarction ◽

Sudden Onset ◽

Restricted Diffusion ◽

Left Middle Cerebral Artery ◽

Magnetic Resonance Imaging Mri ◽

Radiographic Data

Occasionally, acute ischemic stroke can be difficult to differentiate from acute intracranial infection. We describe a patient who presented with sudden onset of right hemiparesis and fever. Magnetic resonance imaging (MRI) was consistent with an acute stroke, showing multiple lesions with restricted diffusion in the left middle cerebral artery territory. These lesions were not enhancing and were not associated with vasogenic edema. A diagnosis of acute stroke was made based on the clinical and radiographic data. Follow-up MRI obtained eleven days later showed interval development of ring enhancement and vasogenic edema surrounding the previously noted core of restricted diffusion. Based on these findings, the diagnosis was revised to cerebral abscesses and the patient was treated successfully with antibiotics. In retrospect, the largest diffusion-weighted lesion on baseline MRI demonstrated two characteristics that were atypical for stroke: it had an ovoid shape and a subtle T2 hypointense core. This case demonstrates that acute clinical and radiographic presentation of cerebral abscess and ischemic stroke can be strikingly similar. Follow-up imaging can be instrumental in arriving at an accurate diagnosis.

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Changes in Spinal Instability After Combined Therapy of Conventional Radiotherapy and Bone Modifying Agents for Painful Vertebral Bone Metastases

10.21203/rs.3.rs-258203/v1 ◽

2021 ◽

Author(s):

Eiji Nakata ◽

Shinsuke Sugihara ◽

Yoshifumi Sugawara ◽

Ryuichi Nakahara ◽

Shouta Takihira ◽

...

Keyword(s):

Combined Therapy ◽

Spinal Metastases ◽

Spinal Instability ◽

Vertebral Metastases ◽

Conventional Radiotherapy ◽

Potential Risk Factors ◽

The Difference ◽

Over Time ◽

Selection Of

Abstract Precise assessment of spinal instability is critical at the beginning and after radiotherapy for selection of the treatment and evaluating the effectiveness of radiotherapy. We investigated changes of spinal instability after radiotherapy and examined potential risk factors for the difference of the outcome of spinal instability for painful spinal metastases. We evaluated 81 patients who received radiotherapy for painful vertebral metastases in our institution between 2012 and 2016. The pain at the vertebrae was assessed. Radiological responses of irradiated vertebrae were assessed by computed tomography. Spinal instability was assessed by Spinal Instability Neoplastic Score (SINS). Follow-up assessments were done at the start of radiotherapy and at 1, 2, 3, 4, and 6 months after radiotherapy. At each of one to six months, pain disappeared in 62%, 84%, 93%, 98%, and 100% of patients. The median SINS were 8, 7, 6, 5, 5, and 4 at the beginning of radiotherapy and after 1, 2, 3, 4, and 6 months, respectively, which significantly decreased over time (P < 0.001). Multivariate analysis revealed that PLISE was the only risk factor for spinal instability at one month. In conclusion, spinal instability significantly improved over time after radiotherapy. Clinicians should take attention to PLISE in the radiotherapy of vertebral metastases.

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Abstract WMP83: Rivaroxaban Therapy Is Not Associated with Hemorrhagic Transformation After Acute Cardioembolic Stroke: A Prospective MRI Study

Stroke ◽

10.1161/str.47.suppl_1.wmp83 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Laura C Gioia ◽

Mahesh Kate ◽

Leka Sivakumar ◽

Hayrapet Kalashyan ◽

Dulara Hussain ◽

...

Keyword(s):

Treatment Initiation ◽

Recurrent Stroke ◽

Hemorrhagic Transformation ◽

Cardioembolic Stroke ◽

Open Label ◽

Open Label Study ◽

Mri Study ◽

Lost To Follow Up ◽

Weighted Sequences

Introduction: Early anticoagulation after cardioembolic stroke remains controversial, due to the potential for symptomatic hemorrhagic transformation (HT). The safety profile of rivaroxaban within 14 days of cardioembolic stroke onset has not been assessed prospectively. Methods: We conducted a prospective, open label study of patients with atrial fibrillation treated with rivaroxaban ≤14 days of mild/moderate ischemic stroke/TIA (NIHSS score≤8) onset. Informed consent was obtained after the decision to treat with rivaroxaban was made by the treating physician. All patients underwent MRI, including susceptibility-weighted sequences, within 24 hours of rivaroxaban initiation and at day 7, with clinical assessment at 90 days. HT was classified using ECASS criteria (hemorrhagic infarct (HI) 1/2, or parenchymal hemorrhage (PH) 1/2). The primary endpoint was symptomatic HT (defined as PH2 associated with an NIHSS increase ≥4 within the study period). Secondary outcomes included any PH at day 7 and recurrent stroke within 90 days of enrolment. Results: Sixty patients were enrolled (mean±SD age 71±19 years, 82% stroke/18% TIA). Median (IQR) time from onset to first rivaroxaban dose was 3(5) days. At treatment initiation, median NIHSS was 2(4) and median DWI volume was 7.9(13.7) ml (range 0-175 ml). Baseline DWI volume was correlated with time to first dose (r=0.58, p<0.001). On baseline MRI, HT was present in 25 patients (42%) (HI1=19, HI2=6). Fifty patients had follow-up MRI at a median 7(4) days after rivaroxaban initiation (4 patients withdrew consent and 6 were lost to follow-up). No patients developed symptomatic HT or PH at any point. New asymptomatic HI1 developed in 3 patients. There was asymptomatic progression from HI1 to HI2 in 5 patients. In the remaining 18 patients with baseline HI and follow-up MRI, there was no change at day 7. Two recurrent ischemic strokes occurred (day 5 and day 28). Two additional patients had new asymptomatic DWI lesions at day 7. Two patients died within 90 days (one recurrent stroke and one pneumonia). Conclusion: These data support the safety of rivaroxaban initiation within 14 days of mild/moderate cardioembolic stroke/TIA. MRI evidence of petechial HT, which is common, does not appear to increase the risk of symptomatic HT.

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Multiattribute Selection of Acute Stroke Imaging Software Platform for Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) Clinical Trial

International Journal of Stroke ◽

10.1111/j.1747-4949.2012.00787.x ◽

2012 ◽

Vol 8 (3) ◽

pp. 204-210 ◽

Cited By ~ 7

Author(s):

Leonid Churilov ◽

Daniel Liu ◽

Henry Ma ◽

Soren Christensen ◽

Yoshinari Nagakane ◽

...

Keyword(s):

Clinical Trial ◽

Acute Stroke ◽

Neurological Deficits ◽

Software Platform ◽

Stroke Imaging ◽

Acute Stroke Imaging ◽

Selection Of

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STUDY OF SIGNIFICANCE OF PHASE MASK IMAGE IN ACUTE STROKE PATIENTS

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2022.008.01.2 ◽

2022 ◽

Vol 8 (1) ◽

pp. 6-10

Author(s):

Krishna Teja Nerella ◽

Dileep Reddy Ayapaneni ◽

Surekha Srikonda

Keyword(s):

Acute Stroke ◽

Hemorrhagic Transformation ◽

Phase Mask ◽

Phase Imaging ◽

Stroke Patients ◽

Arterial Thrombus ◽

Phase Images ◽

Intraparenchymal Haemorrhage ◽

Brain Stroke ◽

Mri Study

Background: Phase images contains information regarding local susceptibility changes between the tissues, which can help measure the iron and other content which changes the local field. Typically, this information is ignored before looking at console. Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique detects an early hemorrhagic transformation within the infarct to provide insight into cerebral hemodynamics following the stroke. Objective: Significance of “phase mask imaging in differentiation of hemorrhage and calcifications” in acute stroke patients. Methods: An observational non-interventional study carried out on 100 patients with stroke and headache symptoms. MRI Brain Stroke Profile with FLAIR, DWI, ADC, SWAN, and Phase mask sequences, done on 3T GE MRI scanner. Results: All patients underwent MRI study with SWI sequence. Of 183 cases, 33%(n=60) patients had microbleeds, 5%(n=10) patients had granulomas, 32%(n=58) patients had arterial thrombus with infarct, 11%(n=20) patients had falx calcifications, 11%(n=20) patients had intraparenchymal haemorrhage, and 8%(n=15) patients had infarcts with haemorrhagic transformation. The sensitivity of phase imaging in the detection of calcification was 90%. Conclusion: Phase mask imaging plays an important role to detect intracranial calcifications and chronic microbleeds. Phase mask imaging acts as a supplement tool in acute stroke patients, which guides further management.

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CLIPPED OR CLIPLESS CHOLECYSTECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.06.262 ◽

2018 ◽

Vol 25 (06) ◽

pp. 805-809

Author(s):

H. Sabiha Akhtar ◽

Zia Farooq ◽

Hassan Rathore ◽

Muhammad Umar Farooq ◽

Arooj Ahmad

Keyword(s):

Treatment Options ◽

P Value ◽

Surgical Removal ◽

Biliary Leakage ◽

Group A ◽

The Difference ◽

Group B ◽

Trial Setting ◽

Selection Of

Background: Cholecystectomy is the surgical removal of the inflamedgallbladder. Advancement in technology has led to many treatment options and methods ofcholecystectomy but the selection of right method depends upon severity of disease alongwith available resources and expertise. Objective: To compare the frequency of biliary leakagewith clipless versus clipped laparoscopic cholecystectomy for management of cholecystitis.Material & Methods: Study design: Randomized control trial. Setting: Unit 1, Departmentof Surgery, Jinnah hospital, Lahore. Duration: It was conducted for a period of six monthsfrom July 2016 to January 2017. Data collection: A total of 130 patients were included in thestudy using nonprobability consecutive sampling and were randomly divided in two groups byusing lottery method. In group A, clip-less Harmonic scalpel was used along with Ultrasonicshear. In group B, the conventional instruments were used with the application of clips. Patientswere called for follow-up in OPD after 1 week to assess biliary leakage through MRCP. All thedata was collected through a pre-designed proforma. The data was entered and analyzed inSPSS version 20. Results: The mean age of patients was 42.97±10.77 years with 68 (52.31%)patients were male and 62 (47.69%) patients were females. The biliary leakage was noted in29 cases i.e. 9 from clipless group and 20 were from clipped group and the difference wasstatistically significant (p-value=0.020) Conclusion: It can be concluded from this study thatthe frequency of biliary leakage is significantly higher in the clipped LC for management ofCholecystitis. Thus it is encouraging to use clipless method to avoid such complication andimprove surgical outcomes.

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