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INTRODUCTION: Diffusion-weighted (DW) MR imaging enables early identification of ischemic lesions in stroke. Stroke subtype may be related to different lesion patterns. The aim of this study was to analyze the subtype of ischemic lesions as determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria by using DW MR imaging. METHODS AND RESULTS: In this study, 510 consecutive patients with ischemic stroke (95%) and transient ischemic attack (5%) aged 65 +/- 12 years were investigated by use of DW MR imaging within 48 hours of the clinical onset of symptoms. Lesions on DW imaging were classified as single, scattered, or multiple lesions in one vascular territory and multiple in more than one vascular territory. We found a significant overall association of DW imaging lesion patterns and classification with stroke subtype by using the TOAST criteria (P < .001). Single corticosubcortical lesions (P < .01) and multiple bilateral lesions in the anterior (AC) and posterior circulation (P < .001) on DW imaging were significantly associated with a cardiac embolic source. Multiple unilateral lesions in the AC were significantly associated with large-artery arteriosclerosis. Because of the 15-mm criterion for small-artery occlusion, cryptogenic stroke was significantly associated with subcortical lesions >/=15 mm. CONCLUSION: We found a strong relationship between stroke subtype and DW imaging lesion pattern. The finding of multiple bilateral lesions was significantly associated with a cardiac embolic source, which may be caused by a specific thrombus texture with a tendency for embolus dissemination.

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PURPOSE: Microangiopathic lesions of the brain tissue correlate with the clinical diagnosis of vascular subcortical dementia. The "experience-based" evaluation is insufficient. Rating scales may contribute to reproducible quantification. MATERIALS AND METHODS: In MRI studies of 10 patients, 9 neuroradiologists quantified vascular white matter lesions (WMLs) at two different points in time for 12 anatomically defined regions with respect to number, size and localization (score). For 9 observers and 10 studies, 90 intra-observer differences were obtained for each of the 12 WML scores. To calculate the inter-observer reliability, rating pairs were formed. Furthermore, 360 differences were computed for each score and rating for 12 anatomically defined WML scores, and the intraclass correlation (ICC) was calculated as a measure of agreement (reliability). RESULTS: As to the intra-observer reliability, the median of the differences was 1.5 for the entire brain as opposed to 0 for defined brain regions. The corresponding values for the inter-observer reliability were 3 and 1, respectively. The mean intra-class correlation coefficient for the 10 studies was 0.88, whereas the mean interclass correlation concerning the inter-observer reliability was 0.70, with the first and second rating being averaged. The rating of each study took about 6 minutes. CONCLUSION: The rating scale with high intra- and inter-observer reliability can dependably quantify WMLs and correlates with the clinical diagnosis of vascular dementia. Using a reliable rating scale, the diagnostic distinction of age-associated physiological vs. pathological size of the WML can make a contribution to the reproducible quantifiable diagnostic evaluation of vascular brain tissue lesions within the framework of dementia diagnostics.

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Myotonic dystrophy (DM) is an autosomal dominant multisystem disorder involving muscle, brain, heart, eyes and endocrine organs, among others. The molecular basis is an unstable trinucleotide repeat at the 3'-untranslated end of the myotonin protein kinase gene on chromosome 19 q 13.3, and the number of repeats correlates with the severity of muscle weakness. We performed a clinical, psychometric and MRI study on 43 patients with DM and correlated findings with the molecular analysis. Nineteen patients had mild distal muscle weakness, 17 moderate und 7 severe weakness. Thirteen had marked cognitive deficits with reduced speed of cognition, low IQ, and apathy. MRI showed pathological muscle signal in 35 cases with a characteristic mosaic involving distal muscle groups, often sparing the posterior tibial muscle. Cerebral MRI showed significant subcortical white matter lesions in 20 cases and brain atrophy in 15 cases. Clinical and MRI findings of CNS and muscle both correlated with CTG repeat length, but did not parallel each other. DM is a significant disease of the brain as well as muscle, and several aspects of the disease correlate with molecular findings, with a threshold effect for repeats exceeding 1000 trinucleotides. The individual predominance of specific organ involvement probably depends on variable somatic mosaicism of the molecular defect.

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Depending on the clinical symptomatology, computed tomography (CT) is the predominant examination technique. CT reliably shows live-threatening intra- or extracerebral hemorrhage. Typical localization and distribution of blood allow differentiation between extradural and/or subarachnoidal effusion. Dislocation of the midline structures or of cortical relief shows the mass effect of intracranial hemorrhage. In many cases localized edema can be identified, but because of the normally very narrow cortical sulci in children and younger people, the general post-traumatic brain swelling is often diagnosed only retrospectively. Magnetic resonance tomography is more sensitive than CT concerning subtle changes in the depth of the white matter and should be used for follow-up studies as a supplementary examination.

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BACKGROUND AND PURPOSE: Because the frequency of hemorrhagic transformation of cerebral infarcts is still a matter of controversy, we performed a prospective magnetic resonance imaging study in a series of consecutive patients with cardioembolic stroke. SUMMARY OF REVIEW: Among 200 consecutive patients with transient ischemic attack or ischemic stroke, 41 were identified with a computed tomographically proven supratentorial infarct due to cardiogenic embolism. Magnetic resonance imaging (T1-weighted) was performed 3 weeks after the stroke in 35 of these 41 patients. Eight patients received anticoagulants. Magnetic resonance images showed hemorrhagic transformation in 68.6% (24) of the 35 infarcts, always without clinical deterioration. In a stepwise forward logistic regression analysis only the volume of infarction edema on the initial computed tomogram was linked significantly with the risk of hemorrhagic transformation (p = 0.037). Hemorrhages were a regular finding on magnetic resonance images of infarcts exceeding a volume of 10 cm3 (94.4%, 17 of 18). CONCLUSIONS: Hemorrhagic transformation is a regular finding in medium-sized and large cardioembolic infarcts. Thus, in therapeutic and preventive studies of acute stroke the severity, not the frequency, of hemorrhages into brain infarcts should be the matter of interest.

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Pneumatosis intestinalis coli seldom causes symptoms of an acute abdomen and is rarely diagnosed in CT. The origin of the gas collections in the wall of the bowel often remains unclear. As shown in our case, pneumatosis may involve any portion of the bowel, but usually spares the rectum. Due to extreme meteorism and coprostasis it can be difficult to recognize pneumatosis radiographically. In CT the gas collections beneath the serosa are well defined, discrete, oval or round.

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On the basis of 26 cases with extracerebral fluid accumulation in the middle cranial fossa the bony changes occurring in this connection are described and discussed in respect of their aetiology. If there are bony accompanying reactions, two entities can be observed in principle. One group shows thinning and protrusion of the temporal squama, raising of the lesser wing of the sphenoid bone and protrusion of the greater wing of the sphenoid bone. The second group is associated with thickening of the temporal squama and of the lesser and greater wing of the sphenoid bone without showing any change in volume of the middle cranial fossa. If we postulate in the first group a space-occupying property of the extracerebral fluid accumulation, the prominent reactions in the second group are those usually associated with absence of pressure exercised on the cranial vault by a space-occupying growth.

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A retrospective study in 33 patients with intracranial meningioma demonstrates that two pathological mechanisms are involved in causing a hypodense area around the actual tumor: pressure-induced atrophy that persists after operation and true cerebral edema of unclear cause. The extent of the hypodense area is not related to tumor location or tumor size. A relationship between meningioma with a malignant tendency and the hemispheric spread of hypodensity can be observed.

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The development of new catheter materials and techniques has made it possible to perform local intraarterial fibrinolysis in the region of the basilar artery in case of thrombotic arterial occlusions. We present the case of a 27-year old patient suffering from thrombosis of the basilar artery in whom local fibrinolysis was performed. The clinical course is demonstrated in respect to imaging methods (angiography, CT and MRT) and electrophysiological monitoring.

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A report on patient presenting in the cranial computer tomogram with changes in the cranium in the left temporal region typical of a meningioma, as well as with changes in the floor of the middle cranial fossa. Correct diagnosis was obtained only by the overall assessment comprising anamnesis, laboratory findings and state of the skeletal structure: namely, a plasmacytoma involving the calotte of the cranium.

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Case report about cerebral infection with the species Nocardia Brasiliensis in a not immunocompromised host. Diagnosis, treatment and neuroradiological findings are shown and compared with current studies.

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