Hypoxic/ischemic brain damage is well-known catastrophic injury. The specific treatment, socalled neuroprotective therapy, aims to prevent or diminish this havoc damage. However, approved neuroprotective therapy in clinical practice is limited. Targeted temperature management (TTM) shows the most promising neuroprotective therapy. Moreover, TTM is also useful for intracranial pressure (ICP) control. Many methods of TTM have been reported. TTM can apply to several clinical conditions associated with hypoxic/ischemic brain injury or elevated intracranial pressure.
Hypoxia-Ischemia, Brain ; Hypoxia, Brain

Hypoxic/ischemic brain damage is well-known catastrophic injury. The specific treatment, socalled neuroprotective therapy, aims to prevent or diminish this havoc damage. However, approved neuroprotective therapy in clinical practice is limited. Targeted temperature management (TTM) shows the most promising neuroprotective therapy. Moreover, TTM is also useful for intracranial pressure (ICP) control. Many methods of TTM have been reported. TTM can apply to several clinical conditions associated with hypoxic/ischemic brain injury or elevated intracranial pressure.

Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all stroke patients. ICH score is a simple tool for outcome prediction for intracerebral hemorrhage patients. The score consists of 5 characteristics including age > 80 years, Glasgow Coma Scale, infratentorial location, hematoma volume and presence of intraventricular hemorrhage that were found to be independent predictors of poor prognosis. The study aimed to validate prediction of 30 days mortality in Thai intracerebral hemorrhage patients. This is a cross-sectional study of patients with ICH in Thammasat University Hospital from 1 January 2011 to 31 December 2011. Independent predictors of 30 days mortality were identifi ed and the ICH score was determined. The study showed that the signifi cant independent parameters were location of hemorrhage, Glasgow Coma Scale, and ICH volume. In multivariate analysis, the signifi cant parameters were infratentorial ICH, Glasgow Coma Scale (3-4), ICH volume > 30 cm3 , and presence of intraventricular hemorrhage. We conclude that ICH score is a useful and reliable tool to predict 30 days mortality in Thai patients, although age > 80 years is not an independent predictor in this study.

Background & Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with risk of ischemic stroke. Atrial electrophysiological properties are influenced by alteration of cardiac autonomic tone. Cardiac autonomic derangement was reported in acute ischemic stroke patients. Atrial activity analysis with sample entropy (SampEn) and atrial fibrillatory rate (AFR) are the useful tools for evaluation of atrial electrophysiological properties. Heart rate variability (HRV) is a good indicator for cardiac autonomic function. We aimed to evaluate atrial activity by SampEn and AFR correlated with HRV in AF patients with acute ischemic stroke compared to which in AF patients with previous ischemic stroke. Methods and Results: Patients (age 69+10 years, n=40) were recruited, thereafter HRV, AFR, and SampEn were analyzed from surface electrocardiogram (ECG). Acute stroke group showed significant decreases in standard deviation of normal-to-normal intervals (SDNN), normalized low frequency (LF) and high frequency (HF) power (138+36 ms vs. 170+61 ms, 13+4 vs. 18+8 and 34+8 vs. 46+15, respectively) compared to post-stroke group. However, there was no significant difference in the LF to HF power (LF/HF) ratio between these two groups (0.41+0.14 vs. 0.43+0.24). Moreover, SampEn did not alter after stroke recovery, while AFR tended to decrease. Conclusions: Atrial electrophysiology properties by SampEn and AFR are not influenced by cardiac autonomic derangement during acute ischemic stroke period.

Background: Solitary pontine infarct is divided into paramedian pontine infarct (PPI) and small deep pontine infarct (SDPI). High-resolution MRI is currently the most useful imaging method to characterize vessel walls and detect atherosclerotic plaques of the intracranial arteries. However, high-resolution MRI is not included in the routine imaging protocol for patient with acute stroke. We intend to determine the role of conventional MRI and MRA of the brain in solitary pontine infarct. Methods: Fifty patients with solitary pontine infarct underwent a MRI study of the brain on T1-weighted image, T2-weighted image and post-gadolinium T1-weighted image to assess the presence of atherosclerotic plaque, and MRA of the brain using 3-dimensional time-of-flight MRA (3D TOF MRA) to assess the basilar artery flow. The basilar artery assesses by axial T2-weighted image was scored as “presence of plaque” or “absence of plaque” and the 3D TOF MRA of the basilar artery is scored as “normal”, “irregular” or “stenosis” ≥ 30%. Pontine infarct is divided into paramedian pontine infarct (PPI) and small deep pontine infarct (SDPI) groups. Results: Thirty-five patients had PPI and 15 had SDPI. Axial T2WI MRI of the brain detected basilar artery plaques in 50% of patients with pontine infarction: 51.4% (18 of 35 cases) in PPI and 46.7% (7 of 15 cases) in SDPI. No plaque was found in all cases of normal-appearing 3D TOF MRA and the plaque was identified in all patients with basilar artery stenosis on the 3D TOF MRA. Conclusion: The basilar artery atherosclerotic branch disease is frequently detected in both groups of solitary pontine infarct (PPI and SDPI). Conventional MRI and MRA of the brain are useful imaging methods that help characterize basilar wall abnormalities.
Magnetic Resonance Imaging