Background and Purpose-We investigated whether transient ischemic attacks (TIAs) before stroke can induce tolerance by raising the threshold of tissue vulnerability in the human brain. Methods-Sixty-five patients with first-ever ischemic territorial stroke received diffusion-and perfusion-weighted MRI within 12 hours of symptom onset. Epidemiological and clinical data, lesion volumes in T2, apparent diffusion coefficient (ADC) maps and perfusion maps, and cerebral blood flow and cerebral blood volume values were compared between patients with and without a prodromal TIA. Results-Despite similar size and severity of the perfusion deficit, initial diffusion lesions tended to be smaller and final infarct volumes were significantly reduced (final T2: 9.

Background and Purpose-In acute ischemic stroke, thrombolytic treatment with recombinant tissue plasminogen activator (rtPA) is limited by a concomitant activation of the coagulatory system, leading to incomplete or delayed reperfusion, microcirculatory disturbances, or even repeated vessel occlusions. Our pilot study sought to assess the therapeutic potential of a new treatment strategy combining rtPA at reduced dosages with a platelet glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitory agent in acute middle cerebral artery occlusion. Methods-Nineteen patients suffering from acute middle cerebral artery occlusion (Thrombolysis in Myocardial Infarction[TIMI] flow grade 0 to 1) underwent combined intravenous thrombolytic treatment using rtPA at reduced dosages and the GPIIb/IIIa antagonist tirofiban. Stroke MRI (diffusion-and perfusion-weighted imaging) and MR angiography were performed at baseline and between days 1 and 2 after treatment. Clinical scores (National Institutes of Health Stroke Scale and modified Rankin Scale) were assessed at baseline and after 1 week. Results-Middle cerebral artery recanalization (TIMI flow grade 2 and 3) occurred in 13 of 19 patients (68%). The ischemic lesion on follow-up MRI was significantly smaller in patients with recanalization compared with those without recanalization (Pϭ0.001). Only patients with recanalization improved neurologically (PϽ0.001). Because no symptomatic hemorrhage was observed, the power of our study to detect a symptomatic bleeding rate of Ն8% was at least 80%. Conclusions-Combined

Paraneoplastic limbic encephalitis is uncommon neurological side effect of cancer in the absence of direct effect of primary tumor or metastasis, side effects of treatment or metabolic dysfunctions (6). Non-Hodgkin's lymphoma triggers such side effect very rarely. We present a case of a young adult with complete clinical course of non- Hodgkin's lymphoma with an episode of behavioral disturbances and MRI features which were pathognomonic for paraneoplastic limbic encephalitis.

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