[Show abstract][Hide abstract] ABSTRACT: The 2010 American Academy of Neurology guideline for the diagnosis of acute ischemic stroke recommends MRI with diffusion weighted imaging (DWI) over noncontrast head CT. No studies have evaluated the influence of imaging choice on patient outcome. We sought to evaluate the variables that influenced one-year outcomes of stroke and TIA patients, including the type of imaging utilized.
Patients were identified from a prospectively collected stroke and TIA database at a single primary stroke center during a one-year period. Data were abstracted from patient electronic medical records. The primary outcome measure was death, myocardial infarction, or recurrent stroke within the following year. Secondary outcome measures included predictors of getting an MRI study.
727 consecutive patients with a discharge diagnosis of stroke or TIA were identified (616 and 111 respectively); 536 had CT and MRI, 161 had CT alone, 29 had MRI alone, and one had no neuroimaging. On multiple logistic regression analysis, there were no differences in primary or secondary outcome measures among different imaging strategies. Predictors of the primary outcome measure included age and NIHSS, while performance of a CT angiogram (CTA) predicted a decreased odds of death, stroke, or MI. The strongest predictor of having an MRI was admission to a stroke unit.
These results suggest that long-term (one-year) patient outcomes may not be influenced by imaging strategy. Performance of a CTA was protective in this cohort. A randomized trial of different imaging modalities should be considered.
Full-text · Article · May 2013 · The Open Neurology Journal
[Show abstract][Hide abstract] ABSTRACT: Cigarette smoking is the most common preventable cause of morbidity and mortality in developed countries. Smokers with brain damage involving the insula are 136 times more likely to stop smoking immediately after the injury than smokers with brain injuries elsewhere.
A 58-year-old woman with a history of hypertension, coronary artery disease, and 40 pack-year history (1 pack per day for 40 years) of smoking presented with sudden confusion and word-finding difficulty. Initial neurological examination showed disorientation to time, difficulty following commands, and perseveration. No focal motor, sensory, or visual deficit was present. Noncontrast head CT showed a new insular ischemic stroke. Five months after discharge from the hospital, the patient reported that she had not resumed smoking cigarettes, had not used any smoking cessation aids, and had not intended to stop smoking. Her daughter reported that "it was as if she forgot that she used to smoke."
Unintentional abrupt smoking cessation serves as a unique lesion localizer. Insular hypocretin transmission plays a permissive role in the motivational properties of nicotine in animals. Whether the mechanism of smoking cessation relates to hypocretin secretion has yet to be proven in humans.
No preview · Article · Apr 2011 · Journal of neuroimaging: official journal of the American Society of Neuroimaging