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Background and Purpose: To analyze standard operating procedures (SOP) of acute stroke imaging and interventions during COVID-19 pandemic with special emphasis on chest CT within a multimodal stroke protocol., Methods: A questionnaire was distributed via email to members of the Professional Organization of German Neuroradiologists (Berufsverband Deutscher Neuroradiologen e.V.)., Results: Answers were received from 25 units: eleven of them acquire chest CT, three in any patient and eight, when COVID-19 is suspected due to body temperature increase, patient's history or when the latter cannot be sufficiently obtained. Preliminary data indicate a high sensitivity and moderate negative predictive value., Conclusion: Different SOP reflect an uncertainty whether chest CT should be acquired as part of a multimodal stroke protocol. Accuracy of low dose chest CT cannot be determined yet. The strengths and limitations of chest CT are discussed.

A stroke is usually caused by ischaemia, less frequently by an intracerebral hemorrhage. The distinction between hemorrhagic and ischaemic strokes, as well as the identification of patients requiring immediate recanalization therapy, cannot be made by clinical examination but requires CT imaging. In most patients with an ischemic stroke, large parts of the affected brain area are functionless throughout the first hours, but not yet irreversibly damaged (penumbra tissue). These areas can be saved through early vessel recanalization. In the acute phase of ischaemic stroke, a delay of 15 minutes results in a significant worsening of the neurologic prognosis.With modern endovascular techniques, even patients with the most severe ischemic strokes have a fair chance of neurological recovery, if they are admitted to a specialised centre within the first few hours., Competing Interests: Prof. Wiesmann ist Berater der Firma Stryker Neurovascular. Er erhielt Vortragshonorare von den Firmen Bracco Imaging, Medtronic, Siemens Healthcare, Stryker Neurovascular.Omid Nikoubashman gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The wrist drop, also called carpoptosis or drop hand, is a common clinical presentation in case of peripheral damage to the radial nerve. But what about the picture of a bilateral finger/wrist drop?! We report the case of a 61-year-old female patient who was admitted to the hospital for myocardial infarction. Subsequently she developed a right dominant bilateral wrist drop. Further neurological examination revealed a positive Wartenberg sign pointing towards a central motoric dysfunction. The following native cerebral CT scan demonstrated bilateral hypodense lesions in both hand knobs in the precentral gyri. Subsequent MRI confirmed acute cerebral infarction in these two but also several other, clinically silent, locations. Further diagnostic work-up revealed a hypokinetic cardiac apex suggesting cardiac embolism to be the cause for cerebral thrombembolism and the clinically leading symptom of right-dominant bilateral finger/wrist drop. Besides the case presentation also the differential diagnosis and clinical test for diagnostic work-up of wrist drops are presented and discussed.

The sense of smell is one of the phylogenetically oldest human senses. Nevertheless the number of publications regarding olfaction is marginal compared with other sensory systems. In recent years, however, there have been enormous advances in understanding the main olfactory processes. These range from the first contact of odorants with receptor cells in the nasal mucosa to the olfactory signal cascade to the processing of olfactory stimuli in the central nervous system. This article focuses on anatomy and physiology of the human sense of smell, which consists mostly of sensory input from two neural systems--the olfactory and trigeminal systems. It considers recent biomolecular experiments and functional neuroimaging studies in humans.

Computed tomography (CT) is the method of choice to detect acute subarachnoid hemorrhage (SAH). The sensitivity of CT has been reported to range from 85 to 100 %. Magnetic resonance imaging (MRI) using FLAIR sequences shows a comparable sensitivity in acute SAH and in some cases can even be superior to CT. However, additional proton density weighted (PDW) TSE sequences or 3D-FLAIR sequences should be used to avoid false-positive results caused by flow artifacts. Conventional T (1)- or T (2)-weighted SE sequences or susceptibility weighted T (2)* or EPI sequences used for the diagnosis of intracerebral hemorrhage do not detect SAH reliably enough. In subacute SAH, starting from day 5 after the suspected hemorrhage, the sensitivity of MRI is clearly superior to CT. Patients with suspected ischemic stroke scheduled for the initial evaluation by MRI no longer need additional CT studies to rule out subarachnoid hemorrhage as long as the MRI protocols are adequate and the radiologist has the necessary experience.

Purpose: We evaluated different techniques of contrast-enhanced phase-inversion ultrasound to visualize renal perfusion., Materials and Methods: Levovist contrast-enhanced phase-inversion ultrasound with different levels of mechanical index and frame rate was performed in 20 kidneys. Analysis using a software algorithm for time-resolved perfusion imaging was compared to single-image analysis performed by three independent radiologists., Results: Optimal depiction of renal perfusion was achieved only by using a mechanical index which was high enough to destroy the microbubbles of the contrast agent (burst imaging) combined with a low frame rate (0.5 images/second). Renal cortex and medulla showed a homogeneous enhancement. Computer-assisted time-resolved perfusion analysis was applicable; it did not show additional Information to single-image analysis., Conclusion: Renal perfusion can be visualized using contrast-enhanced phase-inversion ultrasound. For depiction of bigger vessels, it is equal to B-mode ultrasound or Doppler mode techniques; however, it is superior for visualization of renal parenchymal perfusion.

Purpose: To evaluate MR imaging at 1.5 Tesla in patients suffering from acute subarachnoid hemorrhage (SAH) using proton-density weighted (PDW) fast spin echo (FSE) and fluid attenuated inversion recovery (FLAIR) sequences., Methods: 19 patients suffering from acute SAH as diagnosed by CT were studied 6 h to 3 days after hemorrhage. 10 patients without SAH were studied as a control group. The presence of subarachnoid blood as well as possible artifacts was recorded., Results: In all 19 patients subarachnoid hemorrhage was detected on both FLAIR and PDW images (100%). On the FLAIR images, the cerebral ventricles were partially obscured by flow artifacts in 7 of 19 patients, the basal cisterns in 6 of 19 patients. In 4 of these 13 regions blood was diagnosed on both PDW and CT images, while in the other 9 regions both PDW and CT were unremarkable., Conclusion: The sensitivity of MRI at 1.5 Tesla in the diagnosis of subarachnoid hemorrhage is comparable to CT. The combination of FLAIR and PDW FSE sequences helps to avoid false-positive results caused by flow artifacts.

The role of neuroimaging in the acute setting of head trauma is to diagnose the extent of intracranial injury and to identify all lesions which require urgent neurosurgical treatment. Computed tomography (CT) remains the most important diagnostic tool for initial screening of trauma victims. Although magnetic resonance imaging (MR) has higher sensitivity to most traumatic lesions than CT, due to the ease and speed of CT, and the fact that sufficient monitoring of critically ill patients during the examination is much easier with CT than with MR, mean that MR is not the imaging modality of choice for the initial diagnostic work-up. Recent MR techniques such as FLAIR or diffusion imaging further improve the sensitivity of MR in head trauma. Conventional angiography is currently indicated only for few suspected vascular lesions (e.g. traumatic arterio-venous fistulas, vascular dissections).

The sensitivity of three different enzyme-linked immunosorbent assays (ELISAs: Enzygnost-Rubella/Behring Co., Rubazyme (M)/Abbott Co., Rubelisa M/M.A.B.) was examined for detection of rubella-specific IgM and IgG antibodies. The screening of the sera of 20 s.c. vaccinated persons (rubella strain Cendehill) using these diagnostic systems revealed that the ELISAs are capable to detect the rubella IgG antibodies reliably. Additional haemagglutination inhibition (HI), and single radial haemolysis (SRH) tests confirmed this fact. Antibody kinetics seen in Enzygnost-Rubella are similar to those determined by HI. In contrast, it was found that the Rubazyme test is able to detect largely late IgG antibodies in agreement with the data obtained by SRH, which may be helpful to exclude a rubella reinfection. A result negative in Rubazyme, but positive in HI should indicate a positive rubella IgM test. For the determination of subclass-specific IgG antibodies the sandwich assay was extended to a 4-phases-test, using specific antibodies to IgG1-IgG4. After acute rubella infection or vaccination the antibodies of the IgG3 subclass appear before the other. The rubella antibodies in the IgG3 exceed its quantitative distribution in the total IgG (about 7.5%). The determination of IgM-specific rubella antibodies with the Enzygnost-Rubella and Rubazyme M systems proved also to be rather sensitive and reliable. No interference was seen from rheumatoid factor activity, IgG competition and heterologous IgM. In contrast, the Rubelisa M system should be improved in evaluation procedures. However, since all systems showed also differences to HI using IgM fractions, it seems to be advisable to apply an additional rubella IgM test beside ELISA in critical cases.