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Haque ME, Boren SB, Arevalo OD, Gupta R, George S, Parekh MA, Zhao X, Aronowski J, Savitz SI. Longitudinal, Quantitative, Multimodal MRI Evaluation of Patients With Intracerebral Hemorrhage Over the First Year. Front Neurol 2021; 12:764718. [PMID: 34917017 PMCID: PMC8670985 DOI: 10.3389/fneur.2021.764718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
In most patients with intracerebral hemorrhage (ICH), the hematoma and perihematomal area decrease over the subsequent months but patients continue to exhibit neurological impairments. In this serial imaging study, we characterized microstructural and neurophysiological changes in the ICH-affected brain tissues and collected the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS), two clinical stroke scale scores. Twelve ICH patients were serially imaged on a 3T MRI at 1, 3, and 12 months (M) after injury. The hematoma and perihematomal volume masks were created and segmented using FLAIR imaging at 1 month which were applied to compute the susceptibilities (χ), fractional anisotropy (FA), mean diffusivity (MD), and cerebral blood flow (CBF) in the same tissues over time and in the matching contralesional tissues. At 3 M, there was a significant (p < 0.001) reduction in hematoma and perihematomal volumes. At 1 M, the χ, FA, and CBF were decreased in the perihematomal tissues as compared to the contralateral side, whereas MD increased. In the hematomal tissues, the χ increased whereas FA, MD, and CBF decreased as compared to the contralesional area at 1 M. Temporally, CBF in the hematoma and perihematomal tissues remained significantly (p < 0.05) lower compared with the contralesional areas whereas MD in the hematoma and χ in the perihematomal area increased. The NIHSS and mRS significantly correlated with hematoma and perihematomal volume but not with microstructural integrity. Our serial imaging studies provide new information on the long-term changes within the brain after ICH and our findings may have clinical significance that warrants future studies.
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Affiliation(s)
- Muhammad E Haque
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Seth B Boren
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Octavio D Arevalo
- Biostatistics, Epidemiology, and Research Design Component, Center for Clinical and Translational Sciences, Louisiana State University, Shreveport, LA, United States
| | - Reshmi Gupta
- Department of Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Louisiana State University, Shreveport, LA, United States
| | - Sarah George
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Maria A Parekh
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Xiurong Zhao
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Jaraslow Aronowski
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology, Louisiana State University, Shreveport, LA, United States
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Parekh MA, DeLaGarza C, Johnson J. Common carotid macrothrombosis causing acute ischaemic stroke in a patient with COVID-19. BMJ Case Rep 2021; 14:14/7/e245081. [PMID: 34315756 PMCID: PMC8317114 DOI: 10.1136/bcr-2021-245081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Maria A Parekh
- Neurology, Baylor College of Medicine, Houston, Texas, USA
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Abstract
The authors report a case of fungal otitis media complicated by extension of the infection into adjacent structures causing apical petrositis and subsequently involvement of the jugular foramen in a 71-year-old diabetic man. First described in 1907, Gradenigo's syndrome is a serious but rare clinical triad of acute otitis media, unilateral pain in the distribution of cranial nerve V (trigeminal) and ipsilateral cranial nerve VI (abducens) palsy that commonly presents without all three features and is therefore often missed. In this report, our patient was initially misdiagnosed as having a diabetic cranial neuropathy, and later he developed Vernet's syndrome. Despite aggressive surgical and medical management, he did poorly and died a few weeks later. Clinicians need to be aware of this serious and life-threatening complication of otitis media in high-risk individuals with diabetes or immunocompromised states, to allow early diagnosis and improved clinical outcomes.
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Affiliation(s)
- Maria A Parekh
- Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Vitor H Pacheco
- Neurology, Baylor College of Medicine, Houston, Texas, USA.,Neurology, Michael E DeBakey VA Medical Center, Houston, Texas, USA
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