scholarly journals Perfusion Imaging in Autoimmune Encephalitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Deepak Vallabhaneni ◽  
Muhammad Atif Naveed ◽  
Rajiv Mangla ◽  
Awss Zidan ◽  
Rashi I. Mehta
Keyword(s):  
Case Report ◽  
Gray Matter ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Autoimmune Encephalitis ◽  
Surface Proteins ◽  
Restricted Diffusion ◽  
First Case ◽  
The Brain

Encephalitis is characterized by inflammation of brain tissue and has various infectious and noninfectious causes. CSF analysis and MRI usually reveal inflammatory changes although sometimes brain imaging may be normal. Autoimmune encephalitis is caused by antibodies against neuronal synaptic receptors, surface proteins, or intracellular proteins. In this case report, we present a 65-year-old female who presented with a fall and altered mental status. Workup for infectious etiologies was negative and MRI of the brain displayed focal restricted diffusion with corresponding T2-FLAIR hyperintensity involving gray matter structures, making the diagnosis unclear. CT perfusion of the brain demonstrated increased cerebral blood volume and cerebral blood flow in the left parietooccipital gray matter, with corresponding normal mean transit time. Following treatment failure with acyclovir, antibiotics, and steroids, the patient was found to be positive for GAD65 antibodies and diagnosed with autoimmune encephalitis. Symptoms markedly improved with plasmapheresis. Autoimmune encephalitis rarely causes restricted diffusion and this is the first case report to describe corresponding hyperperfusion on CT perfusion study.

Abstract WP223: Chronic Atherosclerotic Moyamoya Syndrome of the Middle Cerebral Artery: A Hemodynamic Study with CT Perfusion

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kwang Deog Jo ◽  
Woo Sang Kim ◽  
Moon Jung Bae ◽  
Myung Hee Choi ◽  
Jeesue Han ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Moyamoya Syndrome ◽  
Vascular Reserve ◽  
Collateral Network ◽  
Hemodynamic Impairment ◽  
The Brain

Background: Moyamoya vessels, an abnormal vascular collateral network at the base of the brain, are associated with moyamoya disease and secondary moyamoya syndrome. Several studies have suggested that ischemic symptoms in patients with moyamoya vessels are most closely related to hemodynamic impairment. However, few studies have evaluated cerebral perfusion state in secondary atherosclerotic moyamoya syndrome. The purpose of our study was to evaluate cerebral hemodynamics measured by acetazolamide CT perfusion (CTP) imaging in patients with moyamoya syndrome associated with symptomatic atherosclerotic occlusion of the unilateral middle cerebral artery (MCA). Methods: Multidetector helical CTP imaging was performed in 14 patients (mean age, 54.4 years), who were clinically diagnosed to have moyamoya syndrome associated with unilateral atherosclerotic steno-occlusion of the proximal MCA. All patient underwent cerebral angiography and CTP imaging. Hemodynamic quantitative parameters of regional cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT) were measured in the anterior cerebral artery (ACA), MCA, and posterior cerebral artery (PCA) territories of both hemispheres separately. The Cerebral vascular reserve (CVR) capacity was measured using acetazolamide. Results: Mean resting rCBF in the ipsilesional ACA and MCA territories were significantly lower than in the contralateral territories (P<0.05). After acetazolamide infusion, the rCBF was significantly increased in the ipsilesional ACA, PCA, and all three contralateral territories (P<0.05) and rCBV was significantly increased in the all ipsilesional and contralateral territories (P<0.05). The CVR capacity changes were not significantly different between ipsilesional and contralateral territories. Conclusions: These findings suggest that the affected MCA territory has decreased perfusion with poor vasomotor reactivity despite abundant collateral circulation through the basal moyamoya vessels in patients with atherosclerotic moyamoya syndrome.

Abstract 2619: Autoregulation of Cerebral Blood Flow is Preserved in Primary Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
E B Gould ◽  
Rebecca McCourt ◽  
Sana Vahidy ◽  
Negar Asdaghi ◽  
Michael D Hill ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracerebral Hemorrhage ◽  
Cerebral Autoregulation ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Serial Ct ◽  
Acute Intracerebral Hemorrhage ◽  
Perfusion Maps

Background: Treatment of hypertension during acute intracerebral hemorrhage (ICH) is controversial. There are concerns that in the context of disrupted cerebral autoregulation, blood pressure (BP) reduction may cause decreased cerebral blood flow (CBF), particularly in the perihematoma region. CBF was assessed using serial CT perfusion (CTP) studies. We hypothesized that CBF would remain stable following BP reduction. Methods: Acute primary ICH patients were imaged pre and post BP treatment. Perfusion maps were calculated from CTP source images. Mean CBF was measured in a 1cm perihematoma region, contralateral homologous regions and in both hemispheres. Mean cerebral blood volume (CBV), mean transit time (MTT), and time to drain (TTD) were calculated in the same manner. Relative measures (i.e. rCBF) were calculated as ratios/differences between ipsilateral and contralateral regions. Results: Sixteen patients (median age 75 (54-91)) were imaged with CTP (median time from onset 19.4 (2.0-72.2) h) and re-imaged 2.0 (1.1-3.3) h later. Median NIHSS at baseline was 9 (2-24); this remained stable at the time of the second CTP (10 (2-24), P=0.14). Baseline hematoma volume was 24.8±19.9 ml and there was no change at the time of the second CTP (26.3±22.1 ml, P=0.16). Patients were recruited from an ongoing trial, in which they were randomly treated to a target systolic BP of <150mmHg (n=9) or <180mmHg (n=7). Four patients received no antihypertensives as BP was below target at the time of randomization. Mean systolic BP in treated patients (n=12) decreased significantly between the first (165±23 mmHg) and second (143±18 mmHg, P<0.0001) CTP scans. Mean perihematoma CBF in treated patients was stable with BP reduction (pre=35.1±7.1 vs. post=35.4±6.2 ml/100g/min, P=0.87). Ipsilateral hemispheric CBF was also stable (pre=47.3±7.2 vs. post=46.4±7.1 ml/100g/min, P=0.66). Although perihematoma CBF was lower than in contralateral homologous regions (rCBF=0.72±0.11), BP reduction did not decrease this further (0.74±0.14 post-treatment, P=0.58). Ipsilateral hemispheric rCBF (0.96±0.06) was also unaffected by BP treatment (0.95±0.08, P=0.64). Perihematoma rCBF decreased in 5 treated patients, but never by >12%. Linear regression showed no relationship between changes in systolic BP and perihematoma rCBF (R=-0.002, [-0.005, 0.001], P=0.18). Perihematoma rCBV (pre=0.77±0.11 vs. post=0.79±0.10, P=0.20), rMTT (pre=0.51±0.54s vs. post=0.70±0.65s, P=0.26) and rTTD (pre=0.71±1.01s vs. post=0.89±0.84s, P=0.42) also remained stable following BP treatment. Conclusions: Acute BP reduction does not appear to exacerbate perihematoma oligaemia. Stability of CBF following acute BP treatment suggests preservation of cerebral autoregulation in ICH, within the range of arterial pressures studied. These findings support the safety of early BP treatment in ICH.

scholarly journals Anti-NMDA Encephalitis: A Rare Encephalitis in a Child- A Case Report

2020 ◽  
Vol 19 (2) ◽  
pp. 108-111
Author(s):  
Saurav Khetan ◽  
Nikhil Agrawal ◽  
Prakash Rajoli
Keyword(s):  
Case Report ◽  
Japanese Encephalitis ◽  
Viral Encephalitis ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
High Index ◽  
First Case ◽  
High Index Of Suspicion

Anti-NMDA encephalitis is second commonest cause of autoimmune encephalitis among children; however, it is hardly diagnosed and often not considered as one of the differentials when a child presents with encephalitis-related symptoms. In children, it presents mostly with seizures or psychiatric symptoms without prodrome. Here we present a six years old girl who presented with seizures and inappropriate behaviour. We investigated her in the line of viral encephalitis such as Japanese Encephalitis, which is very common in our region. However, results were not suggestive of Japanese Encephalitis and further investigations subsequently lead to diagnosis of anti- NMDA encephalitis. This is probably one of the first case report of this disease in our country. We want to highlight the significance of high index of suspicion for looking out for an organic cause in any child who presents with psychiatric symptoms, along with seizures.

Collateral Circulation Predicts the Size of the Infarct Core and the Proportion of Salvageable Penumbra in Hyperacute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

2015 ◽  
Vol 40 (3-4) ◽  
pp. 182-190 ◽  
Author(s):  
Harri Rusanen ◽  
Jukka T. Saarinen ◽  
Niko Sillanpää
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Collateral Circulation ◽  
Cerebral Blood Volume ◽  
Treatment Time ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
The Impact

Background: We studied the impact of collateral circulation on CT perfusion (CTP) parametric maps and the amount of salvaged brain tissue, the imaging and clinical outcome at 24 h and at 3 months in a retrospective acute (<3 h) stroke cohort (105 patients) with anterior circulation thrombus treated with intravenous thrombolysis. Methods: Baseline clinical and imaging information were collected and groups with different collateral scores (CS) were compared. Binary logistic regression analyses using good CS (CS ≥2) as the dependent variable were calculated. Results: CTP Alberta Stroke Program Early CT Score (ASPECTS) was successfully assessed in 58 cases. Thirty patients displayed good CS. Poor CS were associated with more severe strokes according to National Institutes of Health Stroke Scale (NIHSS) at arrival (15 vs. 7, p = 0.005) and at 24 h (10 vs. 3, p = 0.003) after intravenous thrombolysis. Good CS were associated with a longer mean onset-to-treatment time (141 vs. 121 min, p = 0.009) and time to CTP (102 vs. 87 min, p = 0.047), better cerebral blood volume (CBV) ASPECTS (9 vs. 6, p < 0.001), better mean transit time (MTT) ASPECTS (6 vs. 3, p < 0.001), better noncontrast CT (NCCT) ASPECTS (10 vs. 8, p < 0.001) at arrival and with favorable clinical outcome at 3 months (modified Rankin Scale ≤2, p = 0.002). The fraction of penumbra that was salvageable at arrival and salvaged at 24 h was higher with better CS (p < 0.001 and p = 0.035, respectively). In multivariate analysis, time from the onset of symptoms to imaging (p = 0.037, OR 1.04 per minute, 95% CI 1.00-1.08) and CBV ASPECTS (p = 0.001, OR 2.11 per ASPECTS point, 95% CI 1.33-3.34) predicted good CS. In similar multivariable models, MTT ASPECTS (p = 0.04, OR 1.46 per ASPECTS point, 95% CI 1.02-2.10) and NCCT ASPECTS predicted good CS (p = 0.003, OR 4.38 per CT ASPECTS point, 95% CI 1.66-11.55) along with longer time from the onset of symptoms to imaging (p = 0.045, OR 1.03 per minute, 95% CI 1.00-1.06 and p = 0.02, OR 1.05 per minute, 95% CI 1.00-1.09, respectively). CBV ASPECTS had a larger area under the receiver operating characteristic curve for good CS (0.837) than NCCT ASPECTS (0.802) or MTT ASPECTS (0.752) at arrival. Conclusions: Favorable CBV ASPECTS, NCCT ASPECTS and MTT ASPECTS are associated with good CS along with more salvageable tissue and longer time from the onset of symptoms to imaging in ischemic stroke patients treated with intravenous thrombolysis.

scholarly journals CT Perfusion and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

2013 ◽  
Vol 34 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Charlotte H P Cremers ◽  
Irene C van der Schaaf ◽  
Emerens Wensink ◽  
Jacoba P Greving ◽  
Gabriel J E Rinkel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mean Transit Time ◽  
Delayed Cerebral Ischemia ◽  
Mean Difference

Delayed cerebral ischemia (DCI) is at presentation a diagnosis per exclusionem, and can only be confirmed with follow-up imaging. For treatment of DCI a diagnostic tool is needed. We performed a systematic review to evaluate the value of CT perfusion (CTP) in the prediction and diagnosis of DCI. We searched PubMed, Embase, and Cochrane databases to identify studies on the relationship between CTP and DCI. Eleven studies totaling 570 patients were included. On admission, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time-to-peak (TTP) did not differ between patients who did and did not develop DCI. In the DCI time-window (4 to 14 days after subarachnoid hemorrhage (SAH)), DCI was associated with a decreased CBF (pooled mean difference −11.9 mL/100 g per minute (95% confidence interval (CI): −15.2 to −8.6)) and an increased MTT (pooled mean difference 1.5 seconds (0.9–2.2)). Cerebral blood volume did not differ and TTP was rarely reported. Perfusion thresholds reported in studies were comparable, although the corresponding test characteristics were moderate and differed between studies. We conclude that CTP can be used in the diagnosis but not in the prediction of DCI. A need exists to standardize the method for measuring perfusion with CTP after SAH, and optimize and validate perfusion thresholds.

Optimal thresholds for ischemic penumbra predicted by computed tomography perfusion in patients with acute ischemic stroke treated with mechanical thrombectomy

2017 ◽  
Vol 10 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Katsuharu Kameda ◽  
Junji Uno ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Ct Perfusion ◽  
Characteristic Curve ◽  
Mean Transit Time ◽  
Area Under The Curve ◽  
Ischemic Penumbra ◽  
Optimal Thresholds

Background and purposeOptimal thresholds for ischemic penumbra detected by CT perfusion (CTP) in patients with acute ischemic stroke (AIS) have not been elucidated. In this study we investigated optimal thresholds for salvageable ischemic penumbra and the risk of hemorrhagic transformation (HT).MethodsA total of 156 consecutive patients with AIS treated with mechanical thrombectomy (MT) at our hospital were enrolled. Absolute (a) and relative (r) CTP parameters including cerebral blood flow (aCBF and rCBF), cerebral blood volume (aCBV and rCBV), and mean transit time (aMTT and rMTT) were evaluated for their value in detecting ischemic penumbra in each of seven arbitrary regions of interest defined by the major supplying blood vessel. Optimal thresholds were calculated by performing receiver operating characteristic curve analysis in 47 patients who achieved Thrombolysis In Cerebral Infarction (TICI) grade 3 recanalization. The risk of HT after MT was evaluated in 101 patients who achieved TICI grade 2b–3 recanalization.ResultsAbsolute CTP parameters for distinguishing ischemic penumbra from ischemic core were as follows: aCBF, 27.8 mL/100 g/min (area under the curve 0.82); aCBV, 2.1 mL/100 g (0.75); and aMTT, 7.30 s (0.70). Relative CTP parameters were as follows: rCBF, 0.62 (0.81); rCBV, 0.83 (0.87); and rMTT, 1.61 (0.73). CBF was significantly lower in areas of HT than in areas of infarction (aCBF, p<0.01; rCBF, p<0.001).ConclusionsCTP may be able to predict treatable ischemic penumbra and the risk of HT after MT in patients with AIS.

scholarly journals Bilateral Morning Glory Syndrome with Bilateral Persistent Fetal Vasculature in a Patient with Joubert’s Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ahmad Bilal Araissi ◽  
Alaa Fayed ◽  
Youssef Helmy
Keyword(s):  
Case Report ◽  
Optic Disc ◽  
Fibrous Tissue ◽  
Morning Glory ◽  
Persistent Fetal Vasculature ◽  
Morning Glory Syndrome ◽  
First Case ◽  
Ophthalmologic Examination ◽  
The Brain ◽  
Delayed Growth

Purpose. We report a case of a 1-year-old girl who was referred to us with a cerebellar anomaly and delayed growth and development for bilateral ptosis and poor fixation. Based on our ophthalmologic examination, we concluded that she has bilateral persistent fetal vasculature (PFV) with morning glory syndrome (MGS). A closer look into her neurologic condition revealed that she has Joubert’s syndrome. Observations. External examination revealed bilateral symmetrical ptosis with syndromic facies and her fundus examination revealed a large dysplastic optic disc with anomalous radiating vessels and a fibrous tissue tuft originating from the disc. The left eye showed similar findings in addition to a central excavation and a fibrovascular stalk extending from the optic disc. These findings were consistent with bilateral MGS and bilateral PFV. The brain imaging included a computed tomography scan and magnetic resonance imaging, both of which revealed a “molar tooth appearance” of the midbrain and an anomalous cerebellum suggestive of Joubert’s syndrome. Conclusions and Importance. This is the first case report of a case of bilateral MGS and bilateral PFV associated with Joubert’s syndrome. This case report documents the associated optic nerve disease in these patients, not previously described, which are additive causes of visual compromise in addition to the brain insult.

scholarly journals Pseudotumor cerebri induced by topical application of steroid: a case report

2019 ◽  
Vol 47 (7) ◽  
pp. 3435-3437 ◽  
Author(s):  
Yousef Mohammad ◽  
Bandar N. Aljafen ◽  
Mohammed S. Alnafisah ◽  
Fawaz A. Al-Hussain
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Topical Steroid ◽  
Pseudotumor Cerebri ◽  
First Case ◽  
Pseudotumor Cerebri Syndrome ◽  
Neurology Clinic ◽  
Neuro Imaging ◽  
The Brain ◽  
Tomography Scan

A 19-year-old man visited the neurology clinic for evaluation of a headache and pulsating tinnitus that he had experienced for 2 months. A neurological examination was normal, except for bilateral disc swelling. His medical history was notable for recently diagnosed psoriasis for which he had been applying topical hydrocortisone 2.5% three to four times a day. Neuro-imaging with a computed tomography scan and magnetic resonance imaging/magnetic resonance venography of the brain was normal, except for tortuosity of the optic nerves and dilatation of the optic nerve sheaths. Pseudotumor cerebri syndrome was suspected. Unfortunately, the patient refused a spinal tap to measure the cerebrospinal fluid opening pressure. Excessive application of topical steroid was believed to be the cause of the patient’s pseudotumor cerebri syndrome. The patient’s headache and disc swelling improved after treatment with acetazolamide and cessation of topical hydrocortisone. This is the first case report of a topical steroid associated with pseudotumor cerebri syndrome.

The first case report of a patient with acquired factor XIII deficiency in the context of autoimmune encephalitis

Haemophilia ◽  
2017 ◽  
Vol 23 (5) ◽  
pp. e461-e464 ◽  
Author(s):  
I. Soto ◽  
A. Bernardo ◽  
T. Arias ◽  
C. Ramón ◽  
I. Noval ◽  
...  
Keyword(s):  
Case Report ◽  
Factor Xiii ◽  
Autoimmune Encephalitis ◽  
Factor Xiii Deficiency ◽  
First Case

scholarly journals Utility of computed tomography perfusion in detection of cerebral vasospasm in patients with subarachnoid hemorrhage

2006 ◽  
Vol 21 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Roham Moftakhar ◽  
Howard A. Rowley ◽  
Aquilla Turk ◽  
David B. Niemann ◽  
Beverly Aagaard Kienitz ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Digital Subtraction ◽  
Noninvasive Method ◽  
Computed Tomography Perfusion ◽  
Intent To Treat

Object Digital subtraction (DS) angiography is the gold standard for detecting cerebral vasospasm after subarachnoid hemorrhage (SAH). Computed tomography (CT) perfusion is a recently developed modality for the evaluation of cerebral hemodynamics. This study was conducted to evaluate the potential of using CT perfusion to detect vasospasm in patients with SAH. Methods Fourteen patients between the ages of 41 and 66 years with aneurysmal SAH underwent 23 CT perfusion scans for suspected vasospasm. All patients underwent DS angiography within 12 hours of the CT perfusion scans. The presence of vasospasm on CT perfusion images was determined based on qualitative reading using color maps of mean transit time, cerebral blood flow, and cerebral blood volume as criteria. The presence or absence of vasospasm as retrospectively determined using CT perfusion was compared with DS angiography findings. Of the 23 CT perfusion scans performed, 21 (91%) were concordant with angiography findings in predicting the presence or absence of vasospasm. In 15 of 23 scans, the presence of vasospasm was detected on CT perfusion scans and confirmed on DS angiography studies. In two cases, vasospasm was revealed on DS angiography but was not confirmed on CT perfusion. The degree of agreement between CT perfusion and DS angiography for detection of vasospasm was high (κ = 0.8, p < 0.0001). Conclusions Computed tomography perfusion is an accurate, reliable, and noninvasive method to detect the presence or absence of vasospasm. It can be used as a tool to help guide the decision to pursue DS angiography with the intent to treat vasospasm.

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