[Cerebrotendinous xanthomatosis in a 12-year-old patient with growth disorder].
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Bile Acids and Salts↗
Biomedical subjects
J B Fiebach
Publications and source records attributed to J B Fiebach.
Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI.
BACKGROUND AND PURPOSE: Intravenous recombinant tissue plasminogen activator (rtPA) administration is an effective therapy for ischemic stroke when initiated within 3 hours and possibly up to 6 hours after symptom onset. To improve patient selection, a fast diagnostic tool that allows reliable diagnosis of hemorrhage and ischemia, vessel status, and tissue at risk at an early stage may be useful. We studied the feasibility of stroke MRI for the initial evaluation and follow-up monitoring of patients undergoing intravenous thrombolysis. METHODS: Stroke MRI (diffusion- and perfusion-weighted imaging [DWI and PWI, respectively], magnetic resonance angiography, and T2-weighted imaging) was performed before, during, or after thrombolysis and on days 2 and 5. We assessed clinical scores (National Institutes of Health Stroke Scale [NIHSS], Scandinavian Stroke Scale [SSS], Barthel Index, and Rankin scale) at days 1, 2, 5, 30, and 90. Furthermore, we performed volumetric analysis of infarct volumes on days 1, 2, and 5 as shown in PWI, DWI, and T2-weighted imaging. RESULTS: Twenty-four patients received rtPA within a mean time interval after symptom onset of 3.27 hours and stroke MRI of 3.43 hours. Vessel occlusion was present in 20 of 24 patients; 11 vessels recanalized (group 1), and 9 did not (group 2). The baseline PWI lesion volume was significantly larger (P=0.008) than outcome lesion size in group 1, whereas baseline DWI lesion volume was significantly smaller (P=0.008) than final infarct size in group 2. Intergroup outcome differed significantly for all scores at days 30 and 90 (all P<0.01). Intragroup differences were significant in group 1 for change in SSS and NIHSS between day 1 and day 30 (P=0.003) and for SSS only between day 1 and day 90 (P=0.004). CONCLUSIONS: Stroke MRI provides comprehensive prognostically relevant information regarding the brain in hyperacute stroke. Stroke MRI may be used as a single imaging tool in acute stroke to identify and monitor candidates for thrombolysis. It is proposed that stroke MRI is safe, reliable, and cost effective; however, our data do not prove this assumption. Early recanalization achieved by thrombolysis can save tissue at risk if present and may result in significantly smaller infarcts and a significantly better outcome.
Acute Disease↗
Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia.
BACKGROUND AND PURPOSE: Neuroimaging techniques such as diffusion- and perfusion-weighted MR imaging have been proposed as tools for advanced diagnosis in hyperacute ischemic stroke. There is, however, substantial doubt regarding the feasibility and practicality of applying MR imaging for the diagnosis of stroke on a routine basis, especially with respect to possible delay for specific treatment such as thrombolysis. In this study, we tested whether MR imaging of stroke is safe, fast, and accurate, and whether the gain in additional information can be used in the daily routine without a loss of time and a risk of suboptimal treatment for the patient with stroke. METHODS: Between September 1997 and August 1999, 64 patients with acute ischemic stroke were recruited for MR imaging (ie, diffusion-weighted imaging, perfusion-weighted imaging, MR angiography, T2-weighted imaging) after a baseline CT was performed. We evaluated practicality and feasibility of MR imaging of stroke by analyzing the intervals between symptom onset, arrival, CT, and MR imaging. RESULTS: Sixty-four patients (mean age, 60.9 years) underwent routine CT and MR imaging within 12 hours after stroke onset (n=25, < or =3 hr; n=26, 3-6 hr; n=13, 6-12 hr). Median times to arrival, start of CT, MR imaging, and between CT and MR imaging were 1.625 hours, 2 hours, 3.875 hours, and 1 hour, respectively. Intervals between symptom onset and MR imaging (P<.005), arrival and MR imaging (P<.002), and CT and MR imaging (P=.0007) differed significantly between the early phase of the study and after November 1998, whereas the intervals between symptom onset and arrival, symptom onset and CT, and arrival and CT did not. Hemorrhage could be excluded in all; a perfusion/diffusion match or mismatch could be shown in 63 of 64 patients. CONCLUSION: Practice and experience with MR imaging in a stroke team significantly reduce the time and effort required to perform this technique and thus make 24-hour availability for MR imaging of stroke practical. Assessment of patients with hyperacute stroke is rapid and comprehensive. Image quality can be substantially improved by head immobilization and by mild sedation, if necessary.
Adult↗
[Skull and brain injuries in children].
Our contribution reviews the diagnostic algorithm of head injuries in children. According to the Heidelberg consensus on head injury, patients should be divided into three risk groups. In low-risk patients clinical observation is the method of choice and radiological examinations are usually unnecessary. Patients at medium risk should be observed carefully. Sometimes neurosurgical consultation or CT is necessary. High risk patients in most instances need CT and neurosurgical consultation. Skull X-ray is helpful only in selected cases. A simple fracture as demonstrated by skull X-ray has no therapeutic consequence. However, normal findings in skull X-ray do not exclude intracranial injury. CT is the method of choice to detect intracranial hemorrhage, epi- or subdural hematoma and cerebral contusion. If patients present with severe clinical deficits, CT allows characterization of lesions and initiation of specific therapy.
Brain Injuries↗
A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage.
BACKGROUND AND PURPOSE: Diagnostic imaging in hyperacute ischemic stroke has been revolutionized by the introduction of diffusion- and perfusion-weighted MRI (DWI and PWI). CT, however, is still needed to exclude intracerebral hemorrhage (ICH). The purpose of our study was to determine the diagnostic accuracy of a standardized, multimodal MRI (mMRI) stroke protocol in the qualitative and quantitative assessment of hyperacute ICH (<6 hours). METHODS: We investigated 9 patients with hyperacute ICH with CT followed immediately by a standardized mMRI stroke protocol (DWI, PWI [T2*-WI], FLAIR, T2-WI, and MRA). The time interval between MRI and symptom onset ranged from 3 hours to 5 hours 45 minutes. We analyzed and compared the size of the hematoma on CT and all mMRI images by semiautomatic volumetry. RESULTS: ICH was unambiguously identified on the basis of all mMRI sequences. With increasing susceptibility effect (T2*-WI), the ICH, appearing as an area of hyperintensity with central signal loss, became qualitatively most evident. Regarding quantitation, T2*-WI overestimated (median and mean difference, 18.9%/17.8%; SD final sigma=24.4%) and DWI correlated best (median and mean difference, 3.97%/-4.36%; SD final sigma=37. 42%) with hematoma size on CT. CONCLUSIONS: Multimodal stroke MRI is as reliable as CT in the assessment of hyperacute ICH. Therefore, additional CT is no longer necessary to rule out ICH in hyperacute stroke. The use of mMRI alone in the diagnostic workup of a hyperacute stroke patient saves time and costs while rendering all the critical information needed to initiate an optimal treatment.
Acute Disease↗