Stroke. 39(6) June 2008

Link to journal
Sylaja, P N.; Coutts, Shelagh B.; Krol, Andrea; Hill, Michael D.; Demchuk, Andrew M.; for the VISION Study Group
From the Calgary Stroke Program, University of Calgary, Alberta, Canada.
When to Expect Negative Diffusion-Weighted Images in Stroke and Transient Ischemic Attack.[Letter]
p.1898-1900
Abstract
Background and Purpose-: The frequency of DWI negative cerebral ischemia and clinical factors associated with such a circumstance is not well understood.Methods-: We performed MRI including diffusion-weighted imaging (DWI) in patients with stroke and transient ischemic attack (TIA) within 24 hours of symptom onset and again at 30 days.Results-: Of 401 patients, 103 (25.6%) had an initial negative DWI study. In the DWI negative group, among the stroke patients, 6/26 (23.1%) had infarcts on follow-up MRI (4 lacunar and 2 posterior circulation syndromes) and 1 had a rMTT deficit. Among the TIA patients, 4/63 (6.3%) showed rMTT deficits and 2/63 (3.2%) had infarcts on follow-up MRI.Conclusions-: Baseline perfusion weighted imaging sequences may detect ischemia in a small proportion of DWI negative cases. Only those with brain stem location or lacunar syndrome were DWI negative initially and yet had a follow-up imaging confirmation of infarct or a final clinical diagnosis of stroke.(C) 2008 American Heart Association, Inc.

Shah, Rajiv R. ; Haghpanah, Sepideh ; Elovic, Elie P. ; Flanagan, Steven R. et al
MRI Findings in the Painful Poststroke Shoulder
p. 1808-1813
Abstract
Background and Purpose-: We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics.Method-: Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1- and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression.Results-: Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain.Conclusions-: Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain.(C) 2008 American Heart Association, Inc.