A study on the radiation dose associated with cerebral CT angiography (CTA) and CT perfusion (CTP) was conducted on an anthropomorphic phantom with the aim of estimating the effective dose (E) and entrance skin dose (ESD) in the eyes and thyroid gland during different CTA and CTP protocols. The E was calculated to be 0.61 and 0.28 mSv in CTA with 100 and 80 kV(p), respectively. In contrast, CTP resulted in an estimated E of 2.74 and 2.07 mSv corresponding to 40 and 30 s protocols, respectively. The eyes received a higher ESD than the thyroid gland in all of these protocols. The results of this study indicate that combining both CTA and CTP procedures are not recommended in the stroke evaluation due to high radiation dose. Application of modified techniques in CTA (80 kV(p)) and CTP (30 s) is highly recommended in clinical practice for further radiation dose reduction.
Leukoaraiosis (LA) is a term that defines an abnormal appearance of the subcortical white matter of the brain on neuroimaging. This study was done to evaluate the predictive value of LA in terms of mortality, disability and cognitive decline at three months post-stroke and also to identify the risk factors that are independently associated with LA in a stroke population.
A 55-year-old woman presented with sudden onset of left-sided body weakness and numbness, which was diagnosed as multifocal cerebral infarct with right thalamic bleed. She had concurrent hypertension, diabetes mellitus and chronic kidney disease. She suffered from central poststroke pain and reactive depression as poststroke complications, for which amitriptyline was prescribed. Unfortunately, she developed symptoms suggestive of mania and psychosis upon initiation of medications, which resolved upon withdrawal of amitriptyline. Amitriptyline is effective for treatment of poststroke pain and particularly useful in concomitant depression. Unexpectedly, this patient developed new psychopathologies after initiation of this medication. This case highlights the development of new psychopathologies that could be due to the antidepressant, underlying bipolar disorder or a complication of the stroke itself. Primary care providers need to actively enquire regarding neuropsychiatric symptoms because they can adversely affect the patient's quality of life as well as impede rehabilitation efforts.