Showing papers by "Peter D. Schellinger published in 2000"

Monitoring Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis for Acute Ischemic Stroke With Diffusion and Perfusion MRI

Abstract: 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...

Feasibility and practicality of MR imaging of stroke in the management of hyperacute cerebral ischemia.

Abstract: 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, ≤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.

Poliomyelitic-like illness in central European encephalitis.

Abstract: Article abstract Central European encephalitis (CEE) may be accompanied by myeloradiculitic symptoms in up to 5% of patients. The authors report six patients with a myelitic form of CEE mimicking acute poliomyelitis with bulbar and arm predominance and a poor prognosis. Three patients died. Of the survivors, only one can perform most activities of daily living, but still needs assisted ventilation at night. Autopsy in one patient showed severe cervicothoracic inflammation with changes almost exclusively in anterior horn cells and roots, as typically seen in poliomyelitis.