Neuropathology of central nervous system arterial syndromes. Part I: the supratentorial circulation

Using ex vivo arterial injection and dissection to assess white matter vascularization

Advances in the techniques for assessing human cerebral white matter have recently contributed to greater attention to structural connectivity. Yet, little is known about the vascularization of most white matter fasciculi and the fascicular composition of the vascular territories. This paper presents an original method to label the arterial supply of macroscopic white matter fasciculi based on a standardized protocol for post-mortem injection of colored material into main cerebral arteries combined with a novel fiber dissection technique. Twelve whole human cerebral hemispheres obtained post-mortem were included. A detailed description of every step, from obtaining the specimen to image acquisition of its dissection, is provided. Injection and dissection were reproducible and manageable without any sophisticated equipment. They successfully showed the arterial supply of the dissected fasciculi. In addition, we discuss the challenges we faced and overcame during the development of the presented method, highlight its originality. Henceforth, this innovative method serves as a tool to provide a precise anatomical description of the vascularization of the main white matter tracts.

White matter hyperintensities and cognitive dysfunction in patients with infratentorial stroke

Objective

To determine whether cognitive function is associated with white matter hyperintensities (WMH) in patients with infratentorial stroke.

Methods

This was a retrospective, cross-sectional study. Twenty-four first-ever infratentorial stroke patients between 18 and 60 years of age were enrolled. WMH was evaluated by the Fazekas scale and the Scheltens scale. Cognitive functions were assessed using the Korean Mini-Mental Status Examination (K-MMSE), Rey-Osterrieth Complex Figure Test, and the Seoul Computerized Neuropsychological Test Battery (SCNT) at one month after stroke. All participants were divided into two groups based on the presence of WMH (no-WMH group and WMH group). General characteristics and cognitive functions were compared between the groups.

Results

There were no significant differences in general characteristics, such as age, stroke type, hypertension history, and education level between the two groups. However, K-MMSE in the WMH group was significantly lower compared to the no-WMH group (p<0.05). The verbal learning test score in SCNT was significantly higher in the no-WMH group compared to the WMH group (p<0.05). Executive function in the no-WMH group tended to be higher compared to the WMH group.

Conclusion

Impairment of cognitive function in patients with infratentorial stroke appeared to be associated with WMH. WMH should be carefully evaluated during rehabilitation of infratentorial stroke patients.