scholarly journals FLAIR vascular hyperintensity, an early sign of stroke (case report)

Author(s):  
Wael Hamza Kamr ◽  
Mohannad Saeed Almalki ◽  
Amr M. Ismaeel Saadawy ◽  
Ayman El-Tahan

Abstract Background Generally, Diffusion-weighted MR imaging (DWI) is known to be more sensitive in diagnosis of acute stroke than other MR sequences. However, fluid attenuated inversion recovery (FLAIR) MR sequence founded to be sometimes more sensitive compared to DWI for the diagnosis of hyperacute stroke. Case presentation An 84 years old female patient brought to ER by ambulance due to loss of speech, dizziness and confusion. Neurological examination showed that the patient can raise her left hand and leg while partially moving her right hand and right leg. The patient had slurred speech. Provisional diagnosis was acute stroke and the patient admitted in the hospital. Non contrast CT scan of the brain was done, was negative for stroke. Then MRI was done showed no areas of restricted diffusion at the DWI sequence or ADC map. Prominent high signal vessels at the left temporal region and on Sylvian fissure were noticed on FLAIR sequence that might have suggested early sign of ischemic vascular insult. Conclusions Arterial hyperintensity on FLAIR images can precede diffusion abnormalities and may provide a clue to the early detection of impending infarction.

Author(s):  
Kevin Lian ◽  
Rekha Siripurapu ◽  
Robert Yeung ◽  
Julia Hopyan ◽  
Kenneth T. Eng ◽  
...  

A 40-year-old woman with no significant previous medical history presented with a three month history of ataxia, confusion, memory difficulties, and headaches. Physical examination revealed numbness in the left hand, but was otherwise unremarkable. Magnetic resonance imaging fluid-attenuated inversion recovery (MRI FLAIR) images demonstrated multiple small white matter hyperintensities, including lesions involving the corpus callosum. There were also deep gray nuclei lesions (Figure 1). The corpus callosum lesions involved the central fibers (Figure 2). Post gadolinium T1 images demonstrated enhancement of some of the lesions as well as extensive perivascular and leptomeningeal enhancement (Figure 3). Extensive infectious serology, autoimmune panel, and paraneoplastic antibodies were negative. Lumbar puncture revealed elevated protein (1116 mg/L), but was otherwise normal. Brain biopsy indicated no apparent pathology. The patient was tentatively diagnosed with acute encephalopathy and treated with high dose steroids seven days after presentation. She was subsequently discharged and was sent for rehabilitation.


Trauma ◽  
2016 ◽  
Vol 19 (1) ◽  
pp. 66-68
Author(s):  
Simon WJ Grant ◽  
Moorthy Halsnad ◽  
Steve Colley ◽  
Ian Sharp

Facial lacerations are a common presentation in emergency departments. It is important to appreciate the mechanism of injury and the anatomy of structures involved in penetrating lacerations in the maxillofacial region. A 65-year-old man suffered an accidental penetrating injury with a sharp kitchen knife to the right temporal region. There was a single laceration to the right temporal region. The right eye had no perception to light, a total afferent and efferent pupillary defect and partial ophthalmoplegia. Computerised tomography scan revealed signs of penetration through the skin, temporalis, postero-lateral orbital wall and orbital apex. There was no injury to the globe or either retrobulbar or intracranial haemorrhage. A diagnosis of direct traumatic optic neuropathy was made following consultation with opthalmology and neurosurgery teams. Only two similar cases of penetrating trauma in the temporal region resulting in direct traumatic optic neuropathy have been identified in the literature. This case presentation highlights the structures that are at risk of damage from penetrating trauma in the maxillofacial region.


Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Manabu Inoue ◽  
Michael Mlynash ◽  
Carlo W Cerada ◽  
Nishant K Mishra ◽  
Soren Christensen ◽  
...  

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Yuki Sakamoto ◽  
Arata Abe ◽  
Satoshi Suda ◽  
...  

Introduction: Because acute fluid-attenuated inversion recovery vascular hyperintensities (FVH) represent disordered blood flow, FVH has been considered as a marker of major arterial occlusions. Contrary, the role of absence of FVH (negative-FVH) is unknown. Hypothesis: We hypothesized that negative-FVH may indicate chronic occlusion. Thus, we investigated the clinical characteristics and neuroimaging findings in patients with negative-FVH and major arterial occlusion. Methods: Consecutive acute stroke patients within 24 hours of onset and major arterial occlusion on magnetic resonance angiography (MRA) were studied. All patients were examined using serial angiography to evaluate the presence of recanalization. Patients were classified into two groups (NF: group without FVH, F: group with FVH). Results: Seventy-two patients (49 [68%] males, 76 [66-83] years) were enrolled. Thirty-six (50%) patients were treated with acute recanalization therapy, including the intravenous thrombolysis or endovascular therapy. On admission, 10 patients were NF group and 62 were F group. Initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (2-8) in NF group and 10 (4-21) in F group (p=0.012). The rate of internal carotid artery occlusion was similar between NF and F group (20% vs. 29%, p=0.716). Serial angiography studies revealed that recanalization was achieved in only 1 (10%) of the 10 patients with NF group and 49 (79%) of the 62 patients with F group during hospitalization (p<0.001). When all patients divided into 2 groups based on the presence or absence of recanalization, patients with recanalization were younger (p=0.023), had higher NIHSS (p=0.008), earlier admission (p=0.014), higher prevalence of atrial fibrillation (p=0.010), and frequently treated with acute recanalization therapy (p=0.040). When multivariate regression analysis was conducted, that Negative-FVH (odds ratio 0.061, 95% CI 0.06-0.620, p=0.018) was a negative independent factor associated with recanalization during hospitalization. Conclusions: Negative-FVH was independently associated with no recanalization during hospitalization. Negative-FLAIR may present not acute occlusion but chronic occlusion.


Author(s):  
Christine U. Lee ◽  
James F. Glockner

63-year-old female potential kidney donor with an indeterminate liver mass Axial fat-suppressed FSE T2-weighted (Figure 1.9.1) and SSFP (Figure 1.9.2) images demonstrate a focal lesion with high signal intensity in the right hepatic lobe. Diffusion-weighted image (b=600 s/mm2) and corresponding ADC map (...


Author(s):  
Toshiharu Nomura ◽  
Kouichirou Okamoto ◽  
Hironaka Igarashi ◽  
Masato Watanabe ◽  
Hitoshi Hasegawa ◽  
...  

2016 ◽  
Vol 7 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Mizuki Tagami ◽  
Atsushi Azumi

Purpose: Cyclosporine (CsA) is currently widely used as a primary immunosuppressive agent in ocular disease, particularly in severe uveitis. Posterior reversible encephalopathy syndrome (PRES) is a significant complication of CsA therapy. However, there are no reports of the occurrence of PRES in response to the treatment of uveitis in the ophthalmological area. Case Presentation: We report a case with CsA-associated PRES. A 70-year-old woman with sympathetic ophthalmitis was treated with 50 mg/day of CsA for 1 week. However, the trough level in her blood was too low; thus, we increased the dose to 100 mg/day of CsA with prednisolone. She had headaches, hypertension (systolic blood pressure 180-200 mm Hg), loss of consciousness for several hours, and reduced limb movement, and her MRI showed a high signal intensity in both posterior lobes, consistent with PRES. Examination of the cerebrospinal fluid indicated that it was within normal limits. Her CsA trough level in the blood was within normal ranges on the day of the attack. Her symptoms gradually improved over the next several days; however, she presented with cortical blindness, which lasted for several weeks. Finally, she returned to her baseline values from before the attack. Her MRI findings showed that PRES had essentially disappeared. Conclusion: PRES is not directly associated with the dosage of CsA administered; however, in general, it is well known that PRES can affect strongly immunosuppressed cases undergoing organ and bone marrow transplantation. Nevertheless, our CsA dose was only 100 mg (1.8 mg/kg). In this study, we report on the occurrence of PRES after the administration of CsA to treat sympathetic ophthalmia. To our knowledge, PRES can also occur after the administration of a small dose of CsA; thus, ophthalmologists using CsA should carefully observe the systemic conditions of CsA-treated patients.


Sign in / Sign up

Export Citation Format

Share Document