Norafida Bahari

Background: DSA (digital subtraction angiography) remains the gold standard in assessing the status of cerebral collaterals. Several studies have shown that the presence of good collateral circulation in ischemic stroke patients is associated with better functional outcomes with reduction of morbidity and mortality. Therefore, in this study, we aimed to assess the correlation between the collateral status seen on DSA cerebral angiogram with the clinical presentation of stroke and patients' functional outcomes. Method: We recruited a cohort of ischemic stroke patients who underwent DSA and collected demographic data, stroke risk factors and clinical data, which includes the National Institutes of Health Stroke Scale (NIHSS) scores, at time of admission. We assessed the collateral status and its grading using DSA and categorized based on established criteria. Subsequently we followed up the patients up at 3 months post stroke event to assess their functional outcomes using the modified Rankin Scale (mRS). Results: There was a significant association between good collateral status and favourable outcome in ischaemic stroke patients (p <0.05). We also found that, there is correlation between the NIHSS (upon discharge) and neurological outcome (MRS at 90 day) with Spearman correlation coefficient of 0.849. Conclusion: In conclusion, cerebral collateral status has the ability to prognosticate the functional outcome of ischemic stroke patients.

Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

Emphysematous aortitis is a rare condition that manifests through the presence of air within or surrounding the inflamed aorta. Aortic inflammation may result from either an infective or a non-infective cause. Recognition of this rare condition is important as the resultant clinical deterioration may be rapid and lead to inevitable death. Cross-sectional imaging, with its relatively wide availability, proves an important tool in the diagnosis and subsequent management of this condition. We report two such cases encountered in our centre, with particular focus on the imaging findings on CT.