A study on 70 adult patients with the cerebrovascular accident in Friendship Hospital during 1999-2001 has shown that most of patients were men with ages of 60 and over and history of hypertension. The general mortality rate was 24%. 95.7% of patients had blood clot, mainly in the central grey matter region, with size of 3 cm. Most of the secondary cerebral ventricular haemorrhages related with the conscious disorder. The severe conscious disorder lead to the high mortality rate. The cerebral haemorrhage occurred in many regions such as cerebellum, brain stem. The cerebral haemorrhage combining with encephalocele had a bad prognosis.
Cerebrovascular Accident ; prognosis ; diagnosis

Hemorrhage occurs within 48 hours after accident onset. In fact, there was not any case in which the hemorrhage occurred before 6 hours. 4 week serial and continuous CT scanner imaging showed that hemorrhagic cerebral infarction occurred within 24 hours in 10%, within 7 days in 39% and within 14 days in 54%. In this study, hemorrhagic cerebral infarction occurred within 1 to 3 days in 40%, 4 to 10 days in 50% and 11 to 30 days in 3%. These results are limited because the serial and continuous CT scanner imaging is less to be performed. All of 30 patients have bleeding from middle cerebral artery. CT scanner imaging showed that hemorrhagic infarction occurred in 24 out of 30 patients (80%) and parenchymal hematoma occurred in 6 patients (20%)
Ischemia ; Hemorrhage ; diagnosis ; Cerebrovascular Accident

OBJECTIVE: The aim of this study was to investigate the relationship between the diffusion and perfusion parameters in hyperacute infarction, and we wanted to determine the viability threshold for the ischemic penumbra using diffusion- and perfusion-weighted imaging (DWI and PWI, respectively). MATERIALS AND METHODS: Both DWI and PWI were performed within six hours from the onset of symptoms for 12 patients who had suffered from acute stroke. Three regions of interest (ROIs) were identified: ROI 1 was the initial lesion on DWI; ROI 2 was the DWI/PWI mismatch area (the penumbra) that progressed onward to the infarct; and ROI 3 was the mismatch area that recovered to normal on the follow-up scans. The ratios of apparent diffusion coefficient (ADC), the relative cerebral blood volume (rCBV), and the time to peak (TTP) were calculated as the lesions' ROIs divided by the contralateral mirror ROIs, and these values were then correlated with each other. The viability threshold was determined by using the receiver operating characteristic (ROC) curves. RESULTS: For all three ROIs, the ADC ratios had significant linear correlation with the TTP ratios (p < 0.001), but not with the rCBV ratios (p = 0.280). There was no significant difference for the ADC and rCBV ratios within the ROIs. The mean TTP ratio/TTP delay between the penumbras' two ROIs showed a significant statistical difference (p < 0.001). The cutoff value between ROI 2 and ROI 3, as the viability threshold, was a TTP ratio of 1.29 (with a sensitivity and specificity of 86% and 73%, respectively) and a TTP delay of 7.8 sec (with a sensitivity and specificity of 84% and 72%, respectively). CONCLUSION: Determining the viability thresholds for the TTP ratio/delay on the PWI may be helpful for selecting those patients who would benefit from the various therapeutic interventions that can be used during the acute phase of ischemic stroke.
Acute Disease ; Aged ; Cerebrovascular Accident/*diagnosis ; Female ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Sensitivity and Specificity ; Tissue Survival/*physiology

One of the main reasons for the soaring interest in acute ischemic stroke among radiologists is the advent of new magnetic resonance techniques such as diffusion-weighted imaging. This new modality has prompted us to seek a better understanding of the pathophysiologic mechanisms of cerebral ischemia/infarction. The ischemic penumbra is an important concept and tissue region because this is the target of various recanalization treatments during the acute phase of stroke. In this context, it is high time for a thorough review of the concept, especially from the imaging point of view.
Brain/radiography ; Cerebrovascular Accident/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Research Support, Non-U.S. Gov't ; Tomography, X-Ray Computed

99mTc-ECD SPECT is valuable for the evaluation of cell viability and function. The purpose of the present study was to evaluate the significance of 99mTc-ECD brain SPECT in ischemic stroke. We compared 99mTc-ECD brain SPECT with perfusion and diffusion weighted images (PWI, DWI). Ten patients with acute and early subacute ischemic stroke were included in this prospective study. T2-weighted images (T2WI), DWI, PWI and 99mTc-ECD SPECT were obtained during both the acute/early subacute and late subacute stages. In the case of PWI, time to peak (TTP) and regional cerebral blood volume (rCBV) maps were obtained. The rCBV map and 99mTc-ECD SPECT images were compared in 8 lesions using delta AI. The asymmetry index (AI) was calculated as (Ci - Cc) X 200 / (Ci + Cc); where Ci is the mean number of pixel counts of an ipsilateral lesion and Cc is the mean number of pixel counts of the normal contralateral hemisphere. delta AI was defined as AIacute - AIsubacute in the ischemic core and periphery. PWI and 99mTc-ECD SPECT detected new lesions of the hyperacute stage or of evolving stroke more accurately than T2WI and DWI. 99mTc-ECD SPECT was able to localize the infarct core and peri-infarct ischemia in all lesions in both the acute and the subacute stages. delta AI was higher in the rCBV map than in the 99mTc-ECD SPECT images in the ischemic core (p = 0.063) and in the periphery (p = 0.091). In the 99mTc-ECD SPECT images, delta AI was higher in the ischemic core than in the periphery (p = 0.028). During the subacute stage, 99mTc-ECD SPECT detected all the lesions without the pseudonormalization seen in the MR images of 5/11 lesions. Based on this study, 99mTc-ECD SPECT is comparable to PWI in terms of its ability to detect acute stroke and is more useful than PWI in the case of subacute infarction.
Acute Disease ; Adult ; Aged ; Brain Ischemia/*complications ; Cerebrovascular Accident/*diagnosis/*etiology ; Comparative Study ; Cysteine/*analogs & derivatives/*diagnostic use ; Diffusion ; Female ; Human ; Magnetic Resonance Imaging/methods ; Male ; Middle Age ; Organotechnetium Compounds/*diagnostic use ; Perfusion ; Radiopharmaceuticals/*diagnostic use ; *Tomography, Emission-Computed, Single-Photon