PURPOSE: To compare the detection rate of unenhanced CT, spin-echo T2-weighted, fast fluid-attenuatedin-version- recovery(FLAIR), and diffusion-weighted MR imaging in the diagnosis of hyperacute middle cerebralartery(MCA) territory infarction. MATERIALS AND METHODS: Sixteen patients with clinically proven hyperacute MCAterritory infarction were e-valuated with unenhanced CT and MR. All CT examinations were performed within sixhours of the onset of symptoms and all MR studies were performed within two hours of CT. All images were evaluatedindepen-dently by two radiologists in possession of brief clinical information. Positive imaging criteria wereparenchy-mal hypoattenuation, as seen on CT, and increased signal intensity, as seen on MR. For quantitativeanalysis, we measured the attenuation and signal intensity of the lesion and contralateral normal parenchyma, andper-centage contrast-to-noise ratios(CNRs) of the lesions were also calculated. RESULTS: Positive findings weredetected in all patients on diffusion-weighted images, in 13(81%) on CT, in 10 ( 63 %) on fast FLAIR images, andin 7(44 %) on T2-weighted images. Lesion percentage CNRs were 30% for diffusion-weighted imaging, 15 % for CT, 18% for FLAIR MR imaging, and 16 % for T2-weighted MR imag-ing(p < .004 for diffusion-weighted imaging vs others). CONCLUSION: For hyperacute MCA territory infarction, diffusion-weighted MR imaging was the most sensitive imagingtechnique and unenhanced CT was superior to fast FLAIR or T2-weighted imaging.
Diagnosis ; Humans ; Infarction* ; Magnetic Resonance Imaging* ; Middle Cerebral Artery*

A pulmonary embolism and cerebral infarction are the second and third most common acute cardiovascular diseases after a myocardial infarction. Early diagnosis and appropriate management are important clinical challenges. In this case, a fatal pulmonary embolism and extensive cerebral infarction caused cardiac arrest during spinal anesthesia for total hip replacement surgery. Transesophageal echocardiography indicated a pulmonary embolism and brain CT showed large area of acute infarction at right middle cerebral artery territory. Pulmonary CT angiogram revealed massive pulmonary embolism findings. This paper reviews this case and suggests other preventive modalities.
Anesthesia, Spinal ; Arthroplasty, Replacement, Hip ; Brain ; Cardiovascular Diseases ; Cerebral Infarction ; Early Diagnosis ; Echocardiography, Transesophageal ; Heart Arrest ; Infarction ; Middle Cerebral Artery ; Myocardial Infarction ; Pulmonary Embolism

We experienced a case of acute cerebral infarction during spinal anesthesia. The patient was a seventy years old male with diagnosis of right femur periprosthetic fracture scheduled for a open reduction & internal fixation under spinal anesthesia. Intraoperatively, he developed a mental confusion and his blood pressure decreased from 115/70 mmHg to 80/45 mmHg. After operation, he appeared to have left hemiparesis and left facial palsy. Angiogram revealed thrombus in superior division of the right middle cerebral artery. He expired 3 months after the surgery despite supportive measures.
Anesthesia, Spinal* ; Blood Pressure ; Cerebral Infarction ; Diagnosis ; Facial Paralysis ; Femur ; Humans ; Male ; Middle Cerebral Artery ; Paresis ; Periprosthetic Fractures ; Thrombosis

With the advent of faster scan time and new computer program, a scanning technique called “dynamic computedtomography” has become possible. Dynamic CT consists of performing multiple rappid sequence scans after injectionof contrast material. The authors have evaluated the clinical usefulness of CT and dynamic CT of 93 patients withbrain infarction and/or ischemia during the period of 17 months from April 1983 to Aug. 1983 to Aug. 1984 inDepartment of Radiology, Chonbuk National University Hospital. The results were as follows; 1. The agedistribution ranged from 18 years to 78 years. Among them the most common age group was between 50 years and 59years(40.9%). 2. The sites of brain infarction were cerebral lobes(63 cases,68), basal ganglia(15 cases, 16.1%)and mlultiple sites(6 cases, 6.4%). The common affected site was middle cerebral artery territories. 3. Thecontrast enhancement of acute infarction was noted in 14 cases(17.5%) which occured commonly between 3 days and 2weeks from ictus. 4. The patterns of time-density curve in brain infarction and/or ischemia were as follow: a .Depression of slow wash-in phase was 20 cases(59%). b. Lower peak concentration was 17 cases(50%), c. Lower anddelayed peak concentration was 7 cases(21%), d. No definite peak concentration was 6 cases(18%). First threepatterns of time-density curve were thought as relatively characteristic curve of brain infarction and/orischemia. 5. Two cases that showed negative findings on precontrast CT scan appeared to be positive findings ashypodensity on postcontrast CT scan and were confirmed as brain infarction by dynamic CT. 6. The diagnostic entityof dynamic CT scan were as follows: a. large artery thrombotic infarction were 23 cases (58%). b. lacunarinfarction were 6 cases (15%). c. ischemia were 5 cases (13%), d. normal were 5 cases(13%), In six cases oflacunar infarction which was doubtful hypodensity on pre-and postcontrast CT scan had a marked difference in CT#(HU) on absolute scale graph of dynamic CT, so diagnosis of lacunar infarction could be made easily. 7. Theclinical values of dynamic CT consist in not only diagnosis of lacunar infarction but also evaluation ofeffectiveness of medical or surgical treatment.
Arteries ; Brain Infarction ; Brain ; Depression ; Diagnosis ; Humans ; Infarction ; Ischemia ; Jeollabuk-do ; Middle Cerebral Artery ; Stroke, Lacunar ; Tomography, X-Ray Computed

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of spinal cord compression. Early diagnosis and appropriate management are important, however, diagnosis is often difficult due to variable neurologic deficit. We report on the case of a 69-year-old female patient in right hemiparesis. She was treated with thrombolysis therapy for acute cerebral infarction before being transferred to our hospital. Findings on a cervical spine magnetic resonance image showed spinal epidural hematoma and cord compression. She was prepared to undergo decompressive surgery, however, neurologic deficits began to show improvement. She was managed conservatively and was discharged without deficits approximately nine days after onset.
Aged ; Cerebral Infarction ; Diagnosis ; Early Diagnosis ; Female ; Hematoma, Epidural, Spinal* ; Humans ; Infarction, Middle Cerebral Artery* ; Neurologic Manifestations ; Paresis ; Spinal Cord Compression ; Spine

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.
Angioplasty, Balloon, Coronary ; Atrial Fibrillation* ; Cerebral Infarction ; Diagnosis ; Drug-Eluting Stents ; Embolism ; Humans ; Intracranial Embolism ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction* ; Stroke*

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.
Angioplasty, Balloon, Coronary ; Atrial Fibrillation* ; Cerebral Infarction ; Diagnosis ; Drug-Eluting Stents ; Embolism ; Humans ; Intracranial Embolism ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction* ; Stroke*

Brain ; pathology ; Brain Infarction ; diagnosis ; Cerebral Angiography ; Cerebral Arterial Diseases ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Posterior Cerebral Artery ; pathology

Using different models of focal cerebral ischemia, the temporal and spatial rules of metabolism and energy changes in the post-ischemia brain tissue were measured by proton magnetic resonance spectroscopy (1HMRS) to provide valuable information for judging the prognosis of acute focal cerebral ischemia and carrying out effective therapy. Nine healthy Sprague-Dawly rats (both sexes) were randomly divided into two groups: The rats in the group A (n = 4) were occluded with self-thrombus for 1 h; The rats in the group B (n = 5) were occluded with thread-emboli for 1 h. The 1H MRS at 30, 40, 50, 60 min respectively was examined and the metabolic changes of NAA, Cho and Lac in the regions of interest were semiquantitatively analyzed. The spectrum integral calculus area ratio of NAA, Cho, Lac to Pcr + Cr was set as the criterion. The values of NAA.Cho in the regions of interest were declined gradually within 1 h after ischemia, especially, the ratio of Cho/(Pcr + Cr), NAA/(Pcr + Cr) at 60 min had significant difference with that at 50 min (P < 0.05). The ratio of Lac/(Pcr + Cr) began to decrease at 40 min from initial increase of Lac in both A and B groups. MR proton spectrum analysis was a non-invasive, direct and comprehensive tool for the study of cellular metabolism and the status of the biochemical energy in acute ischemia stroke.
Brain Ischemia/*diagnosis ; Energy Metabolism ; Infarction, Middle Cerebral Artery/diagnosis ; *Magnetic Resonance Spectroscopy ; Phosphorylcholine/metabolism ; Random Allocation ; Rats, Sprague-Dawley

Magnetic resonance (MR) imaging techniques that measure cerebral perfusion have become increasingly important. It is due to the limitation of other imaging modalities (single photon emission computed tomography, SPECT ; positron emission tomography, PET etc.) and conventional MR imaging to detect cerebral perfusion, and its ability to identify and quantitate changes in cerebral perfusion may have a substantial effect on both the diagnosis and treatment of cerebrovascular disease. We evaluated the cerebral perfusion and arterial recanalization of large territorial infarction in acute, subacute and chronic stage by MR image and MR angiography and tried to correlate with motor improvement. Twenty six patients with large territorial infarction of middle cerebral artery (MCA, n=23) or posterior cerebral artery (PCA, n=3) were included in this study. In conjunction with conventional brain MR imagings, thirty-four dynamic susceptibility contrast-enhanced MR imagings (DSC-MRI) and MR angiography were performed in acute (< lweek, n=22), subacute (1-3 weeks, n=7), and chronic (3-5weeks, n=5) stages of cerebral infarction. Regional cerebral blood volumes (rCBVs) were calculated on a pixel-by-pixel basis and rCBV images were generated. Perfusion of infarcted areas were compared to contralateral normal regions by rCBV ratio (rCBV of infarcted area/that of contralateral), and arterial recanalization of infarcted area were investigated by MR angiographies. Motor power of the hemiparetic side of the patients was observed during the first 5 weeks after the stroke onset. The rCBVs of ischemic regions increased in subacute period than acute period and decreased again in chronic period (p<0.01, Kruskal Wallis one-way ANOVA), and these patterns were also correlated with visual findings of rCBV images. Recanalization of occluded arteries was found on MR angiagraphy in 3 patients (13.69.1) in acute, 6 patients (85.7%) in subacute and 4 patients (80.0%) in chronic infarction. The increase of "rCBV ratio" was more frequently seen in recanalization than no recanalization cases but we could not statistically analyze the difference due to small size of sample. In MCA infarctions, there is no significant relationship between rCBV with motor improvement during first 5 weeks after the onset. DSC-MRI is noninvasive, more widely available than other functional images (SPECT and PET) and easier to perform in an emergency setting. By providing information about hemodynamics, which is not available with conventional T1 or T2-weighted images, DSC-MRI will be helpful in describing the pathaphysiologic characteristics of stroke.
Angiography ; Arteries ; Blood Volume ; Brain ; Cerebral Infarction* ; Diagnosis ; Emergencies ; Hemodynamics ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion* ; Positron-Emission Tomography ; Posterior Cerebral Artery ; Stroke ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon