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Objectives: The present study aimed to examine the effectiveness of proton magnetic resonance spectroscopy (1HMRS) in determining the progression of neurological symptoms resulting in acute ischemic stroke in patients with lenticulostriate artery (LSA) infarction., Materials and Methods: 1HMRS was performed within 72 h after neurological symptom onset. Voxel of interest was placed in tissue that included the pyramidal tract and identified diffusion weighted echo planar spin-echo sequence (DWI) coronal images. Infarct volume in DWI was calculated using the ABC/2 method. 1HMRS data (tNAA, tCr, Glx, tCho, and Ins) were analyzed using LCModel. Progressive neurological symptoms were defined as an increase of 1 or more in the NIHSS score. Patients who underwent 1HMRS after progressive neurological symptoms were excluded., Results: In total, 77 patients were enrolled. Of these, 19 patients had progressive neurological symptoms. The patients with progressive neurological symptoms were significantly more likely to be female and had higher tCho/tCr values, higher rates of axial slices ≥ 3 slices on DWI, higher infarct volume on DWI, higher maximum diameter of infarction of axial slice on DWI, and higher SBP on admission compared to those without. Multivariable logistic analysis revealed that higher tCho/tCr values were independently associated with progressive neurological symptoms after adjusting for age, sex, and initial DWI infarct volume (tCho/tCr per 0.01 increase, OR 1.26, 95% CI 1.03-1.52, P = 0.022)., Conclusions: Increased tCho/tCr score were associated with progressive neurological symptoms in patients with LSA ischemic stroke. Quantitative evaluation of 1HMRS parameters may be useful for predicting the progression of neurological symptoms., Competing Interests: Declaration of Competing Interest Dr. Maruyama received research support from Eisai Co., Ltd, Pfizer Inc., Takeda Pharmaceutical Company Limited, Otsuka Pharmaceutical Co., Ltd, Nihon Pharmaceutical Co., Ltd., Shionogi Co., Ltd., Teijin Pharma Limited, Fujifilm Holdings Corporation, Boehringer Ingelheim, Sumitomo Dainippon Pharma Co., Ltd., Nihon Medi-Physics Co., Ltd., Bayer AG, Merck Sharp & Dohme Corp., Daiichi Sankyo Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi S.A., Novartis International AG, Kowa Pharmaceutical Co., Ltd., Astellas Pharma Inc., Tsumura & Co., Japan Blood Products Organization, Mitsubishi Tanabe Pharma Corporation, and Mylan N.V. The other authors declare they have no conflicts of interest., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We describe a case of bilateral caudate nucleus infarction caused by cardioembolic stroke associated with a variant circle of Willis. The patient was an 81-year-old man with atrial fibrillation who presented with a sudden disturbance of consciousness. When he became more alert a few days later, he was abulic with no spontaneous speech or activity. A magnetic resonance imaging scan of the brain revealed cerebral infarction of bilateral caudate nucleus heads and the left frontal lobe. The left A1 segment was absent on 3-dimensional computed tomography angiography. One year later, abulia had completely resolved. Bilateral caudate nucleus infarction with variant circle of Willis is rare., (Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

A 57-year-old man was admitted because of left hemiparesis. A magnetic resonance imaging scan of the brain revealed a recent infarct from the dorsal side of the right putamen to the corona radiata. Three hours after onset, he complained of rotational vertigo. Truncal ataxia was also found on standing a few days later, which persisted until the chronic phase. Repeat magnetic resonance imaging scans on days 2 and 11 revealed no additional lesions. The present case indicates that rotational vertigo might result from a small, supratentorial, subcortical lesion., (Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Brain microbleeds (BMBs) can be detected on the gradient-echo T2*-weighted magnetic resonance imaging and are considered a risk factor for cognitive impairment and intracerebral hemorrhage. Detailed radiologic findings on the etiology of BMBs and their changes remain scarce. We present a case of subacute change in a BMB in the basal ganglia that mimicked a subacute lacunar infarct. Our findings underscore the need for physicians to be careful to not erroneously diagnose BMBs as lacunar infarctions and prescribe unnecessary antiplatelet medication., (Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.)