• Journal of radiological science and technology
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• v.23 no.1
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• pp.39-47
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• 2000

In this study, we showed a comparison and analysis making use of DWI(diffusion weighted image) using early diagnosis of cerebral Infarction and with the classified T2 weighted image, FLAIR images signal intensity for brain infarction period. period of cerebral infarction after the condition of a disease by ischemic stroke. To compare 3 types of image, we performed polynomial warping and affined transform for image matching. Using proposed algorithm, calculated signal intensity difference between T2WI, DWI, FLAIR and DWI. The quantification values between hand made and calculated data are almost the same. We quantified the each period and performed pseudo color mapping by comparing signal intensity each other according to previously obtained hand made data, and compared the result of this paper according to obtained quantified data to that of doctors decision. The examined mean and standard deviation for each brain infarction stage are as follows ; the means and standard deviations of signal intensity difference between DWI and T2WI for each period are $197.7{\pm}6.9$ in hyperacute, $110.2{\pm}5.4$ in acute, and $67.8{\pm}7.2$ in subacute. And the means and standard deviations of signal intensity difference between DWI and FLAIR for each period are $199.8{\pm}7.5$ in hyperacute, $115.3{\pm}8.0$ in acute, and $70.9{\pm}5.8$ in subacute. We can quantificate and decide cerebral infarction period objectively. According to this study, DWI is very exact for early diagnosis. We classified the period of infarction occurrence to analyze the region of disease and normal region in DW, T2WI, FLAIR images.

• Journal of Korean Neurosurgical Society
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• v.64 no.5
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• pp.763-775
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• 2021

Objective : Hemorrhagic transformation (HT) can be occurred after acute cerebral infarction. HT can worse symptoms in severe cases and adversely affect long-term prognosis. As bone and vascular smooth muscle are composed of type 1 collagen, we aimed to identify a potential relationship between bone mineral density (BMD) and HT after acute cardioembolic stroke. Methods : As an indicator of BMD, we used mean frontal skull Hounsfield unit (HU) values on brain computed tomography (CT). Multivariative hazard ratios were calculated using Cox regression analysis to identify whether the osteoporotic condition was an independent predictor of HT after acute cardioembolic stroke. Results : This 11-year analysis enrolled 506 patients who diagnosed as acute cardioembolic infarction. The first tertile of skull HU value was an independent predictor of HT development compared to the third tertile (hazard ratio, 2.12; 95% confidence interval, 1.13-3.98; p=0.020). We observed no interactions between age and skull HU with respect to HT statistically. Conclusion : The results of this study revealed an association between osteoporotic conditions and HT development after acute cardioembolic stroke. A convenient method to measure the cancellous bone HU value of the frontal skull using brain CT images may be useful for predicting HT in patients with acute cerebral infarction.

• Journal of Korean Neurosurgical Society
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• v.59 no.4
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• pp.400-404
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• 2016

We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke.

• Journal of radiological science and technology
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• v.26 no.3
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• pp.25-31
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• 2003

This study was performed to evaluate the usefulness of Deconvolution perfusion CT in patients with acute cerebral infarction. Nine patients with acute cerebral infarction underwent conventional CT and cerebral perfusion CT within 23 hours of the onset of symptoms. The perfusion CT scan for each patient was obtained at the levels of basal ganglia and 1cm caudal to the basal ganglia. By special imaging software, perfusion images including cerebral blood volume(CBV), cerebral blood flow(CBF), and mean transit time(MTT) maps were created. The created lesions were evaluated on each perfusion maps by 3 radiolocical technician. MTT delay time was measured in the perfusion defect lesion and symmetric contralateral normal cerebral hemisphere. Lesion sire were measured on each perfusion map and compared with the value obtained by diffusion weighted MR imaging(DWMRI). All perfusion CT maps showed the perfusion defect lesion in all patients. There were remarkable CT delay in perfusion defect lesion. In comparison of lesion size between each perfusion map and DWMRI, the lesion on CBF map was the most closely correlated with the lesion on DWMRI(7/9). The size of perfusion defect lesion on MTT map was larger than that of lesion on DWMRI, suggesting that m map can evaluate the ischemic penumbra. Deconvolution Perfusion CT maps make it possible to evaluate not only ischemic core and ischemic penumbra but also hemodynamic status in perfusion defect area. These results demonstrate that perfusion CT can be useful to the diagnosis and treatment in the patients with acute cerebral ischemic infarction.

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.331-336
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• 2007

Objective : The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. Methods : From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. Results : All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. Conclusion : We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.

• Journal of the Korean Society of Radiology
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• v.4 no.3
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• pp.13-18
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• 2010

Purpose : Diffusion tensor imaging(DTI) allows the visualization of fiber tract damage in patients with cerebral infarction. The purpose of this study is to evaluate the correlation between degree of NIH stoke scale and fractional anisotropy (FA) in patient with cerebral infarction. Material and Methods : 16 patients aged 36~77 years(male : 11, female : 5, mean age : 61y), diagnosed cerebral infarction by diffusion weighted imaging(DWI), underwent 24 directional diffusion tensor imaging(DTI). Patients had the DTI taken within 3days of stroke onset. Comparison of DWI, FA value on DTI were measured infarcted area and counter part of specific region of interest (ROI). And evaluation of differences between clinically improved patient group (n=9) and unimproved patient group (n=7) until 2 week follow up after development of cerebral infarction. Clinical status was scaled by NIH stroke scale. Results : Quantitative measurements of FA confirmed statistically the significant diffusion changes in the infarct compared with the matched-counter part region. In DWI, the infarcted area shows high signal intensity, however FA value on DTI was lower than normal brain parenchyma. The FA value of clinically improved patient by NIH stroke scale was 0.49, and the value of contralateral normal brain parenchyma was 0.41. On the contrary, FA value of infarcted area shows about 15% lower than normal brain parenchyma. But, the FA value of unimproved patient by NIH stroke scale represents a half those of contralateral normal brain parenchyma (0.28 on infarcted area vs. 0.56 on normal brain parenchyma). So, the FA value of unimproved patient group was considerably less than those of improved. Conclusion : It is concluded that the unimproved patient group after cerebral infarction showed much less FA value than that of normal brain parenchyma. The FA value of DTI may be one of the useful parameter to predict outcome of cerebral infarction patients.

• The Journal of the Society of Stroke on Korean Medicine
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• v.6 no.1
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• pp.17-23
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• 2005

1. Purpose : The purpose of this study was done to compare the sex, past history, hematologic relationship between the Cerebral infarction patients and the Cerebral hemorrhage patients. 2. Methods : We selected the two study groups. The one is 20 Cerebral infarction patients and the other 20 Cerebral hemorrhage patients with confirmed by Brain CT or MRI. We made an investigation into past history. We examined and made a comparative study of CBC, LFT, Na, K, Cl in the both group. 3. Result & Conclusion : In the Cerebral hemorrhage group, there were many patients with Hypertension and Diabetes mellitus than the Cerebral infarction group. In the Cerebral infarction group, there were many patients with abnormal RBC count with no significant. Also, ESR is higher than the other group. Between the Cerebral infarction and the other group, we discovered significant cases with abnormal triglyceride, ALP in the Cerebral infarction group(p<0.05). Abnormal triglyceride is known one of important risk factor of Cerebral infarction, but this study was significant in the Cerebral hemorrhage group. Also, ALP was significant in the Cerebral hemorrhage group. Therefore more extensive research is needed.

• Journal of Physiology & Pathology in Korean Medicine
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• v.26 no.6
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• pp.929-933
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• 2012

This study was done to examine the prognosis according to onset and duration of treatment in acute ischemic cerebral infarction patients. We analysed NIHSS(National Institutes of Health Stroke Scale) score of acute ischemic cerebral infarction patients who visited department of Internal Korean Medicine, one medical center in Busan from January to December 2009. We divided patients into two groups by the initial time of treatment. Group A is admitted within 7 days, Group B is admitted from 7 to 14 days. We used NIHSS for functional recovery after 3 weeks later from admission day, and analyzed prognostic factor by analysis of covariance. All patients showed statistically significant improvement after 1week, 2weeks, 3weeks from admission, and between 1st week and 2nd week. However, there was no significant difference between 2nd week and 3rd week. NIHSS recovery score after 3weeks were analysed according to the timing of treatment. There was a statistically significant difference between two groups. The percentage of aggravated patients showed no statistically significant difference between the two groups. This study suggests that earlier admission care has an effect on functional recovery of patients with acute ischemic cerebral infarction. Further research on the large scale and long-term follow up is required.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.388-391
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• 2011

A lesion that is hyperintense on diffusion-weighted imaging (DWI) and hypointense on the apparent diffusion coefficient (ADC) map is a characteristic magnetic resonance imaging (MRI) finding in acute ischemic infarction. In some cases, however, these findings can persist for a few months after infarct onset. It is thought that these finding reflect the different evolution speeds of the infarcted tissue. We report a patient with a right middle cerebral artery territory infarction with persistent hyperintensity on DWI and hypointensity on the ADC map for over 8 months. To our knowledge, this is the most persistent case of hyperintensity lesion on DWI and the serial MRI images of this patient provide important information on the evolution of infarcted tissue.

• Journal of Korean Neurosurgical Society
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• v.38 no.6
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• pp.419-424
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• 2005

Objective : Short-term coexisting intracerebral hemorrhage and cerebral infarctions defined as the recurrent stroke presented with different type within three weeks. Despite the high recurrence rate of stroke, little attention and insufficient clinical data had been given to short-term coexisting intracerebral hemorrhage and cerebral infarction's features. This study aims to estimate the risk factors and present the clinical features of short-term coexisting intracerebral hemorrhage and cerebral infarctions. Methods : We investigated 18 patients with short-term coexisting intracerebral hemorrhage and cerebral infarctions who were admitted to our hospital between January 1995 and January 2005. They were subdivided by the recurrence interval such as a group of within one week and another of between one and three weeks as hyperacute and acute respectively. Results : The mean interval between strokes was 6.64 days. Lesional analysis showed that short-term coexisting intracerebral hemorrhage and cerebral infarctions in this study occurred at the other side in 12 cases [66.7%]. The abnormality on the electrocardiographic feature [23.5%] and long-term history of hypertension [20.5%] were the most common risk factors. However, short-term history of diabetes was more common in hyperacute group than in acute group [P<0.05]. The mean number of risk factors was three in acute group. It is larger than that of hyperacute group [P<0.05]. Conclusion : If the patients who experienced cerebrovascular attack have many risk factors, they tend to be the cases of acute coexisting intracerebral hemorrhage and cerebral infarctions than hyperacute. Therefore, that cases are required to be vigilant to the change of patients' state up to three weeks in the treatment.