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Proportion and causes of brain infarction among young persons may differ between Western world and developing countries, which may require different diagnostic and treatment strategies. We compared a Thai series of 56 hospitalized brain infarct patients younger than 50 years (16% of 357 similar patients from all ages) with a series of 55 Dutch patients (8% of 694 patients). The Thai patients had 12% (95% confidence interval: 3–21) more often a cardioembolic stroke cause, due to a higher frequency of rheumatic heart disease in the Thai series. The percentage of patients with atherothrombotic stroke cause was higher in the Dutch series, whereas the percentage of those with hematologic abnormalities, or those with vasculopathies did not differ. Patients in the Thai series had 17% (95% confidence interval: 7–27) more often an unidentified stroke cause, which was probably related to less extensive ancillary investigations compared with the Dutch series. We conclude that especially centers in developing countries that treat young stroke patients should be supplied with ancillary testing facilities, such as cardiac echo, carotid ultrasound, and some laboratory facilities. Early treatment of infections, especially acute rheumatic fever, could lower the incidence of stroke in the young.

In a retrospective study 2015 CT scans were studied for the presence of basal ganglia calcifications. These were discovered in 33 cases. No abnormalities in serum calcium or phosphate levels or any other specific clinical symptoms related to these calcifications were found. It is concluded that basal ganglia calcifications casually detected by CT generally have no clinical significance.

From a prospective registry of 103 stroke patients on early anticoagulation for cardiac embolus we selected 23 patients with a small deep infarct. We studied the incidence of hemorrhagic infarction on CT, and the risk of early anticoagulation. We found no hemorrhagic infarction on CT in any case, and no bleeding complications during the three week observation period. Obviously, early anticoagulation can be started safely in patients with a small deep infarct possibly caused by cardiac embolism.

A patient is presented suffering a hemiparesis. Megadolicho-vascular malformation of the intracranial part of the internal carotid arteries and some of its branches and of the basilar artery was suggested by CT and confirmed by angiography. The value of CT compared with angiography in relation to intracranial megadolicho vascular malformations is discussed.

Cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa are presumed to be related to a megadolicho basilar artery, if present. Since there are no large series of patients with such vascular anomaly, a bias in relating symptoms with the presence of a megadolicho basilar artery is not excluded. We therefore studied retrospectively the incidence of megadolicho and dolicho basilar artery on cranial CT-scan of 3332 patients of 50 years and older. Patient records were reviewed for the above mentioned symptoms. 12 out of 22 patients with a megadolicho basilar artery and 2 patients out of 40 with a dolicho basilar artery had one or two of these symptoms. It is concluded that a megadolicho basilar artery can cause cranial nerve dysfunction, obstruction hydrocephalus, signs of brain stem dysfunction, and signs of a space-occupying lesion in the posterior fossa.