1
|
Fakkert RA, Koopman MS, Scheerder MJ, Beenen LFM, Weber NC, Preckel B, van Hulst RA, Weenink RP. Computer tomography perfusion patterns in iatrogenic cerebral arterial gas embolism: A retrospective cohort study. Eur J Radiol 2024; 170:111242. [PMID: 38043382 DOI: 10.1016/j.ejrad.2023.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Cerebral arterial gas embolism (CAGE) occurs when air or medical gas enters the systemic circulation during invasive procedures and lodges in the cerebral vasculature. Non-contrast computer tomography (CT) may not always show intracerebral gas. CT perfusion (CTP) might be a useful adjunct for diagnosing CAGE in these patients. METHODS This is a retrospective single-center cohort study. We included patients who were diagnosed with iatrogenic CAGE and underwent CTP within 24 h after onset of symptoms between January 2016 and October 2022. All imaging studies were evaluated by two independent radiologists. CTP studies were scored semi-quantitatively for perfusion abnormalities (normal, minimal, moderate, severe) in the following parameters: cerebral blood flow, cerebral blood volume, time-to-drain and time-to-maximum. RESULTS Among 27 patient admitted with iatrogenic CAGE, 15 patients underwent CTP within the designated timeframe and were included for imaging analysis. CTP showed perfusion deficits in all patients except one. The affected areas on CTP scans were in general located bilaterally and frontoparietally. The typical pattern of CTP abnormalities in these areas was hypoperfusion with an increased time-to-drain and time-to-maximum, and a corresponding minimal decrease in cerebral blood flow. Cerebral blood volume was mostly unaffected. CONCLUSION CTP may show specific perfusion defects in patients with a clinical diagnosis of CAGE. This suggests that CTP may be supportive in diagnosing CAGE in cases where no intracerebral gas is seen on non-contrast CT.
Collapse
Affiliation(s)
- Raoul A Fakkert
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Miou S Koopman
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Maeke J Scheerder
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Ludo F M Beenen
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Nina C Weber
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Benedikt Preckel
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Robert A van Hulst
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Robert P Weenink
- Anesthesiology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands; Hyperbaric Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.
| |
Collapse
|
2
|
Dogariu OA, Dogariu I, Vasile CM, Berceanu MC, Raicea VC, Albu CV, Gheonea IA. Diagnosis and treatment of Watershed strokes: a narrative review. J Med Life 2023; 16:842-850. [PMID: 37675172 PMCID: PMC10478671 DOI: 10.25122/jml-2023-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/25/2023] [Indexed: 09/08/2023] Open
Abstract
Watershed strokes have been described previously as ischemic strokes located in vulnerable border zones between brain tissue supplied by the anterior, posterior, and middle cerebral arteries in the distal junction between two non-anastomotic arterial territories. Ischemic strokes in border zones are well-recognized entities and well-described in terms of imaging features, but the pathophysiological mechanism of brain injury production is not fully defined. Border zone ischemia is caused by cerebral hypoperfusion through decreased cerebral blood flow and arterial embolism in unstable atheroma plaque. It is often difficult to say which mechanisms are fully responsible for producing cerebral ischemic lesions. This review aimed to highlight the imaging aspect of watershed strokes and to correlate the clinical characteristics of this type of stroke with the diagnostic algorithm for optimal therapeutic management. Neurologists should promptly recognize this type of stroke and investigate its etiology in the shortest possible time.
Collapse
Affiliation(s)
- Oana Andreea Dogariu
- University of Medicine and Pharmacy, Craiova, Romania
- Department of Neurology, Emergency County Hospital, Targu-Jiu, Romania
| | - Ioan Dogariu
- Department of Neurology, Emergency County Hospital, Targu-Jiu, Romania
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University of Bordeaux, Bordeaux, France
| | - Mihaela Corina Berceanu
- University of Medicine and Pharmacy, Craiova, Romania
- Department of Cardiology, County Hospital, Craiova, Romania
| | - Victor Cornel Raicea
- University of Medicine and Pharmacy, Craiova, Romania
- Department of Cardiology, County Hospital, Craiova, Romania
| | - Carmen Valeria Albu
- University of Medicine and Pharmacy, Craiova, Romania
- Department of Neurology, Neuropsychiatry Hospital, Craiova, Romania
| | - Ioana Andreea Gheonea
- University of Medicine and Pharmacy, Craiova, Romania
- Department of Radiology, Emergency County Hospital, Craiova, Romania
| |
Collapse
|
3
|
Ono R, Iwahana T, Kato H, Okada S, Kobayashi Y. Literature reviews of stroke with hypereosinophilic syndrome. IJC HEART & VASCULATURE 2021; 37:100915. [PMID: 34888412 PMCID: PMC8636825 DOI: 10.1016/j.ijcha.2021.100915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
Hypereosinophilic syndrome (HES) is defined by persistently elevated blood eosinophil levels and is associated with evidence of organ damage. Cardiovascular involvement in HES is most commonly associated with Loffler endocarditis (cardiac HES). Cardiac HES is typically characterized by progressive subendocardial fibrosis with overlying mural thrombus formation, leading to restrictive dysfunction of the left ventricle. The thrombus from cardiac HES could result in cardiogenic stroke; however, most of the stroke cases with HES were not associated with huge thromboembolism rather multiple infarcts in the watershed area. The major clinical features of 97 previously reported cases of stroke with HES are as follows: the median age was 52 years, of which 61 (63%) were men; the initial presenting symptoms were neurological (73%), followed by headache (16%), respiratory symptoms (9%), and visual symptoms (9%). Almost half of the cases were diagnosed with cardiac HES. The characteristics of cardiac findings were mural thrombi, endomyocardial fibrosis, and a restrictive pattern of heart failure. Cerebral findings revealed 78 cases (80%) were described as multiple infarctions and 55 cases (57 %) were involved with watershed areas, whereas 11 cases (11%) were described as embolic stroke for one proximal large-vessel occlusion. Regarding treatment, 71 (73%), 28 (29%), and 16 (16%) patients were treated with steroids, anticoagulants, and antiplatelets, respectively. The overall mortality and recovery rates were 11% and 89%, respectively. Physicians should know most cases of stroke with HES are characterized by multiple infarctions in the watershed area, and cardiac HES is not always associated with stroke.
Collapse
Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Hirotoshi Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| |
Collapse
|
4
|
Tennenbaum J, Groh M, Venditti L, Campos-Gazeau F, Chalayer E, De Broucker T, Hamidou M, Hunault M, Lyoubi A, Meunier R, Muron T, Sène D, Slama B, Guidoux C, Lefèvre G, Kahn JE, Denier C, Rohmer J. FIP1L1-PDGFRA-Associated Hypereosinophilic Syndrome as a Treatable Cause of Watershed Infarction. Stroke 2021; 52:e605-e609. [PMID: 34304603 DOI: 10.1161/strokeaha.121.034191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke has been reported in various conditions associated with eosinophilia. FIP1L1-PDGFRA fusion ([Fip1-like 1-platelet-derived growth factor receptor alpha]; F/P) leads to the proliferation of the eosinophilic lineage and thus to a clonal hypereosinophilic syndrome that is highly responsive to imatinib. METHODS We previously reported on a nationwide retrospective study of 151 patients with F/P-associated clonal hypereosinophilic syndrome. Patients from this cohort with a clinical history of ischemic stroke (as well as 2 additional cases) were further analyzed to better define their clinical picture and outcomes. RESULTS Sixteen male patients (median age, 51 [43-59] years) with low-to-intermediate cardiovascular risk were included. Median National Institutes of Health Stroke Scale was 4 (range, 1-6). Most cerebral imaging disclosed multiple bilateral infarctions of watershed distribution (69%). Despite frequent cardiac involvement (50%), cardiac thrombus was evidenced in a single patient and, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment), 62.5% of strokes were presumably of undetermined etiology. Among the 15 patients treated with imatinib, and after a median follow-up of 4.5 years, stroke recurred in only 3 patients (consisting of either cardio embolic or hemorrhagic events, unrelated to the first episode). CONCLUSIONS F/P+ clonal hypereosinophilic syndrome is a diagnosis to consider in patients with unexplained ischemic stroke and hypereosinophilia (especially in the setting of multiple cortical borderzone distribution) and warrants prompt initiation of imatinib.
Collapse
Affiliation(s)
- Juliette Tennenbaum
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, Hôpital Foch, Suresnes, France (M.G., J.R.)
| | - Laura Venditti
- Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | | | - Emilie Chalayer
- Department of Hematology and Cell Therapy, Saint-Priest-en-Jarez, France. (E.C.)
| | - Thomas De Broucker
- Department of Neurology, Hôpital Delafontaire, Saint Denis, France (T.D.B., A.L.)
| | - Mohamed Hamidou
- Department of Internal Medicine, CHU de Nantes, France (M. Hamidou)
| | | | - Aicha Lyoubi
- Department of Neurology, Hôpital Delafontaire, Saint Denis, France (T.D.B., A.L.)
| | | | - Thierry Muron
- Department of Oncology, Saint-Priest-en-Jarez, France. (T.M.)
| | - Damien Sène
- Department of Internal Medicine, CHU Lariboisière, Paris, France (D.S.)
| | - Borhane Slama
- Department of Hematology, Hôpital d'Avignon, France (B.S.)
| | - Céline Guidoux
- Department of Neurology, CHU Bichat, Paris, France (C.G.)
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, CHU Lille, France (G.L.)
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, CHU Ambroise Paré, Boulogne-Billancourt, France (J.-E.K.)
| | - Christian Denier
- Department of Neurology, CHU du Kremlin-Bicêtre, France (J.T., L.V., C.D.)
| | - Julien Rohmer
- National Reference Center for Hypereosinophilic syndromes (CEREO), France (J.T., M.G., M. Hamidou, G.L., J.-E.K., J.R.).,Department of Internal Medicine, Hôpital Foch, Suresnes, France (M.G., J.R.)
| |
Collapse
|
5
|
Wang G, Jing J, Li J, Pan Y, Yan H, Meng X, Zhao X, Liu L, Li H, Wang DZ, Wang Y, Wang Y. Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial. Stroke Vasc Neurol 2020; 6:80-86. [PMID: 32958697 PMCID: PMC8005909 DOI: 10.1136/svn-2020-000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 01/15/2023] Open
Abstract
Background and purpose The relationship of high-sensitive C-reactive protein (hs-CRP) levels and infarction numbers with the prognosis of stroke is uncertain. This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack (TIA). Methods A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial. The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up. Infarction numbers were classified as multiple acute infarctions (MAIs), single acute infarction and no acute infarction (NAI). The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models. Results Among the 807 patients, 84 (10.4%) patients had a recurrent ischaemic stroke within 1 year. After adjustment for conventional confounding factors, patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year (16.7% vs 3.5%, HR 4.68, 95% CI 1.54 to 14.23, p=0.007), compared with those with non-elevated hs-CRP levels and NAI. Similar results were observed for the composite events. Conclusions Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone, which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA. ClinicalTrials.gov Registry (NCT00979589).
Collapse
Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Z Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
6
|
Pu Y, Liu X, Wang Y, Meng X, Jing J, Zou X, Pan Y, Wang A, Zhao X, Johnston SC, Wang Y, Atchaneeyasakul K, Liebeskind DS, Liu L. Higher early recurrence risk and potential benefit of dual antiplatelet therapy for minor stroke with watershed infarction: subgroup analysis of CHANCE. Eur J Neurol 2020; 27:800-808. [PMID: 31997490 DOI: 10.1111/ene.14156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 01/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Y. Pu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - X. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Meng
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - J. Jing
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Zou
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Y. Pan
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - A. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - X. Zhao
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - S. C. Johnston
- Dell Medical School University of Texas at Austin TX USA
| | - Y. Wang
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | | | | | - L. Liu
- Department of Neurology Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | | |
Collapse
|
7
|
Introna A, Mezzapesa DM, Petruzzellis M, Savarese M, Chiumarulo L, Zimatore DS, Dicuonzo F, Simone IL. Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter? Neurol Sci 2019; 40:1419-1424. [PMID: 30937557 DOI: 10.1007/s10072-019-03868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear. METHODS Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA). RESULTS All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection. CONCLUSIONS We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.
Collapse
Affiliation(s)
- Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Petruzzellis
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Mariantonietta Savarese
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Luigi Chiumarulo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Sergio Zimatore
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| |
Collapse
|
8
|
Wang G, Jing J, Pan Y, Meng X, Zhao X, Liu L, Li H, Wang D, Wang Y, Wang Y. Does all single infarction have lower risk of stroke recurrence than multiple infarctions in minor stroke? BMC Neurol 2019; 19:7. [PMID: 30621613 PMCID: PMC6325885 DOI: 10.1186/s12883-018-1215-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single acute infarction (SAI) usually had lower risk of stroke recurrence than multiple acute infarctions (MAIs) in minor stroke. To evaluate whether all SAI had lower risk of stroke recurrence than MAIs in minor stroke. METHODS We derived data from the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Minor stroke were categorized into SAI and MAIs by infarction numbers in diffusion weighted imaging. SAI were classified as lacunar infarction and non-lacunar infarction. The outcome was stroke recurrence within one-year follow-up. We assessed the associations between infarction patterns and stroke recurrence using multivariable Cox regression models. RESULTS Overall, 834 patients with minor stroke were included in this subgroup, 553 SAI (381 lacunar infarction, 172 non-lacunar infarction) and 281 MAIs. The rate of stroke recurrence was 7.6%, 15.1% and 15.3% in lacunar infarction of SAI, non-lacunar infarction of SAI and MAIs at one year, respectively. Compared with MAIs, lacunar infarction of SAI had lower risk of stroke recurrence (hazard ratio [HR] 0.41, 95% confidence interval [CI] 0.21-0.80, P = 0.009), but not in non-lacunar infarction of SAI (HR 1.01, 95% CI 0.60-1.69, P = 0.98). CONCLUSIONS Lacunar infarction of SAI have lower risk of stroke recurrence than MAIs, while non-lacunar infarction of SAI might have similar risk as MAIs. Except for the number of infarctions, size and location should also be considered to stratify risk of stroke recurrence in minor stroke. TRIAL REGISTRATION http://www.clinicaltrials.gov Unique identifier: NCT00979589 . Date of registration: September 2009.
Collapse
Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - David Wang
- Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
| | | |
Collapse
|
9
|
El-Gammal TM, Bahnasy WS, Ragab OAA, Al-Malt AM. Cerebral border zone infarction: an etiological study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:6. [PMID: 29780226 PMCID: PMC5954770 DOI: 10.1186/s41983-018-0008-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Border zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI. Methods This study was conducted on 76 cerebral BZI patients and 20 healthy control subjects. Patients were divided to group I included 26 internal BZI, group II included 19 cortical BZI and group III included 21 mixed internal/cortical BZI patients. Included subjects were submitted to neurological examination, laboratory investigations, ECG, echocardiogram, brain CT and/or MRI and extra and intracranial blood vessels imaging by duplex and CT angiography. Results Hypertension was significantly higher among groups I and III compared to group II while atrial fibrillation (AF) was significantly higher in groups II and III than group I (p < 0.05). Sonographic duplex assessment of extra and intracranial blood vessels revealed significant increase in mean flow velocities of CCA, ICC and MCA on both side in groups I and III compared to group II (p < 0.05). CT angiography revealed non-significant differences between BZI patients and control as well as in between the three BZI patient's groups regarding the existence of vertebral artery hypoplasia and/or circle of Willis anomalies. Conclusions Vascular stenosis is the main etiological factor in internal BZI while AF is the predominant etiological factor of cortical BZI. Congenital vascular anomalies play roles in the localization of BZI but cannot predispose to it except when comorbid with hemodynamic disturbances.
Collapse
Affiliation(s)
| | - Wafik Said Bahnasy
- Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Tanta, 31527 Egypt
| | - Osama Abd Allah Ragab
- Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Tanta, 31527 Egypt
| | - Ayman Mohammed Al-Malt
- Department of Neuropsychiatry, Faculty of Medicine, Tanta University, Tanta, 31527 Egypt
| |
Collapse
|
10
|
Chen X, Liu K, Wu X, Wang S, Li T, Xing Y. Microembolic Signals Predict Recurrence of Ischemic Events in Symptomatic Patients with Middle Cerebral Artery Stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:747-755. [PMID: 29395677 DOI: 10.1016/j.ultrasmedbio.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Middle cerebral artery (MCA) stenosis is a common cause of ischemic stroke in Asian populations. We sought to determine whether microembolic signals (MESs) can predict the occurrence or recurrence of ischemia in symptomatic and asymptomatic patients with MCA stenosis. The symptomatic group had a significantly higher incidence of MES (30% vs. 16.2%, p < 0.05), as well as higher incidences of cerebral infarction and transient ischemic attack (TIA) (infarction, 13.0% vs. 4.4%, OR 3.123 [95% CI, 1.049-9.294], p < 0.05; TIA, 21.0% vs. 2.9%, OR = 7.108 [95% CI, 1.808-27.949], p < 0.001) than the asymptomatic group. After a follow-up period of 0.5-4.5 y, the subgroup of MES-positive (MES+) symptomatic patients had a significantly higher incidence of TIA (36.7% vs. 14.3%, OR = 1.623 [95% CI, 1.166-2.258]; p < 0.001) than the subgroup of MES-negative (MES-) symptomatic patients. The likelihood of the early occurrence of an endpoint event was also higher in the subgroup of MES+ symptomatic patients. In the group of asymptomatic patients with MCA stenosis, no significant differences were identified between the MES+ and MES- subgroups.
Collapse
Affiliation(s)
- Xiaomin Chen
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Xiujuan Wu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Sibo Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ting Li
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Yingqi Xing
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China.
| |
Collapse
|
11
|
The Phenolic Components of Gastrodia elata improve Prognosis in Rats after Cerebral Ischemia/Reperfusion by Enhancing the Endogenous Antioxidant Mechanisms. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:7642158. [PMID: 29765502 PMCID: PMC5885496 DOI: 10.1155/2018/7642158] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/24/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
Abstract
Pharmacological or spontaneous thrombolysis in ischemic stroke triggers an outbreak of reactive oxygen species and results in neuron death. Nrf2-mediated antioxidation in cells has been proved as a pivotal target for neuroprotection. This research reports that phenolic components of Gastrodia elata Blume (PCGE), a traditional Chinese medicine, can alleviate the pathological lesions in the penumbra and hippocampus by increasing the survival of neurons and astrocytes and improve neurofunction and cognition after reperfusion in a rat model of middle cerebral artery occlusion. LDH assay indicated that pretreatment of cells with PCGE (25 μg/ml) for 24 h significantly reduced H2O2-induced cell death in astrocytes and SH-SY5Y cells. Western blot showed that the nucleus accumulation of Nrf2 and the expression of cellular HO-1 and NQO-1, two of Nrf2 downstream proteins, were increased in both cells. BDNF, an Nrf2-dependent neurotrophic factor, was also upregulated by PCGE in astrocytes. These results illustrated that PCGE can reduce the cerebral ischemia/reperfusion injury and improve prognosis by remedying the cell damage within affected tissues. The protective effects of PCGE seem to be via activation of a Nrf2-mediated cellular defense system. Therefore, PCGE could be a therapeutic candidate for ischemic stroke and other oxidative stress associated neurological disorders.
Collapse
|
12
|
Li Y, Li M, Zhang X, Yang S, Fan H, Qin W, Yang L, Yuan J, Hu W. Clinical features and the degree of cerebrovascular stenosis in different types and subtypes of cerebral watershed infarction. BMC Neurol 2017; 17:166. [PMID: 28851301 PMCID: PMC5576255 DOI: 10.1186/s12883-017-0947-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Whether there are differences in pathogenesis among different types and subtypes of cerebral watershed infarction (WSI) is controversial since they have been combined into a single group in most previous studies. Methods We prospectively identified 340 supratentorial WSI patients at Beijing Chao-Yang Hospital, Capital Medical University, China and classified them based on diffusion-weighted imaging(DWI) templates. Baseline characteristics, clinical courses and neuroradiological features were compared among patients with different types and subtypes of WSI. Results We identified 92 patients with cortical watershed infarction (CWI), 112 with internal watershed infarction (IWI) and 136 with mixed-type infarction. Compared with CWI patients, more IWI patients had critical stenosis of internal carotid artery (ICA) (P < 0.001). For the CWI group, patients with anterior watershed infarction (AWI) were more prone to critical ICA stenosis than those with posterior watershed infarction (PWI) (P = 0.011). For the IWI group, critical ICA stenosis was more prevalent in patients with partial IWI (P-IWI) than in those with confluent IWI (C-IWI) (P = 0.026). IWI patients were more frequently found to have clinical deterioration during the first 7 days of hospitalization and a poor prognosis at the 90th day than in CWI patients (P = 0.003 and P = 0.014, respectively). Conclusions IWI, especially the P-IWI subtype, is associated with hemodynamic impairment (HDI), whereas CWI has a weaker correlation with ICA steno-occlusion. Furthermore, IWI patients are more prone to poor prognosis. Electronic supplementary material The online version of this article doi: (10.1186/s12883-017-0947-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yue Li
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Man Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Zhang
- Department of Neurology, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Shuna Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Huimin Fan
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Wei Qin
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Lei Yang
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Junliang Yuan
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China
| | - Wenli Hu
- Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 South Gongti Road, Chaoyang district, Beijing, 100020, China.
| |
Collapse
|
13
|
The Pathophysiology of Watershed Infarction: A Three-Dimensional Time-of-Flight Magnetic Resonance Angiography Study. J Stroke Cerebrovasc Dis 2017; 26:1966-1973. [PMID: 28694111 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/08/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most of the time, watershed infarcts (WIs) involve steno-occlusive carotid disease. The pathophysiological mechanism could be predicted by their pattern: internal WIs (IWIs) are thought to be due to hemodynamic impairment in contrast to cortical WIs (CWIs), which are more likely to be caused by microembolic phenomena. We used a 3D time-of-flight (TOF) magnetic resonance angiography (MRA) study to assess this hypothesis. METHODS In 45 consecutive patients with a recent WI and ipsilateral cervical carotid stenosis, clinical and radiological data were obtained retrospectively. 3D TOF MRA were analyzed both qualitatively and quantitatively (internal carotid and anterior, middle and posterior cerebral arteries). Then, 2 groups were determined depending on their radiological patterns: WIs with (IWI+) or without (IWI-) an internal watershed. RESULTS Thirty-two of the 45 patients (71%) had IWIs that were or were not associated with CWIs (IWI+), while 13 patients (29%) had only CWIs (IWI-). There was no significant relationship between the radiological pattern and the demographic data, the cardiovascular risk factors, or the degree of stenosis. However, IWI+ patients more frequently had motor weakness (P = .03) than CWI patients. An ipsilateral reduced middle cerebral artery intensity on 3D TOF MRA in both qualitative and quantitative analyses was significantly associated with IWI+. Instead within IWI-, no significantly reduced signal intensity was found. CONCLUSION These findings originally support the view that IWIs are mainly caused by a hemodynamic impairment related to carotid stenosis, whereas CWIs are mostly due to a microembolic mechanism. 3D TOF MRA, which gives pertinent information on pathophysiology on IWIs, can help in decision making.
Collapse
|
14
|
Abstract
Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes.
Collapse
Affiliation(s)
- Clio Rubinos
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA
| | - Sean Ruland
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA.
| |
Collapse
|
15
|
Mejdoubi M, Signate A, Colombani S, Arrigo A, Olindo S. Magnetic resonance imaging characteristics of ischemic stroke in an Afro-Caribbean population: A 1-year prospective MRI study on 534 consecutive patients. J Neuroradiol 2016; 44:31-37. [PMID: 27836651 DOI: 10.1016/j.neurad.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSES Few population-based MRI studies on stroke, particularly in African-descent populations, are available. Based on a 1-year Afro-Caribbean population-based study MRI, ischemic stroke characteristics were extensively analyzed. METHODS All strokes occurring in Martinique (390,371 inhabitants) were prospectively included. Ascertainment was based, whenever possible, on MRI. All patients were categorized as single- (subclassified as cortical, cortical-subcortical, subcortical, lacunar) or multiple-lesion pattern, and vascular (single, multiple or junctional) territory. Brain parenchyma was evaluated, based on visualization of macrobleeds, microbleeds, white-matter hyperintensities or stroke sequelae. Etiology was classified according to TOAST criteria. RESULTS Among 596 ischemic stroke patients included, 534 (295 men, 239 women; mean age, 71 [range 23-110] years) underwent MRI (median delay 1 day). Four hundred and eighty-eight had single-type lesion (14.8% cortical, 42.4% cortical-subcortical, 14.5% subcortical, 16.6% lacunar), involving anterior cerebral (4%), middle cerebral (63.7%), posterior cerebral artery (10.4%) or basilar trunk (11.7%) territories, with 10.3% simultaneously involving multiple territories and 4.9% junctional infarction. Etiologies were LAA (11.2%), SVD (10.7%), CE (29.6%), rare (4.5%) or undetermined (44.1%). CONCLUSION Our prospective, consecutive, ischemic stroke series gives a comprehensive description of ischemic stroke imaging patterns and etiologic distributions in an Afro-Caribbean population with high socio-economic status. Our patients' stroke characteristics are close to those of European-descent populations.
Collapse
Affiliation(s)
- M Mejdoubi
- Department of neuroradiology, Pierre-Zobda-Quitman hospital, university hospital of Martinique, route de La Meynard, 97261 Fort-de-France, Martinique.
| | - A Signate
- Department of neurology, Pierre-Zobda-Quitman hospital, university hospital of Martinique, 97261 Fort-de-France, Martinique
| | - S Colombani
- Department of neuroradiology, Pierre-Zobda-Quitman hospital, university hospital of Martinique, route de La Meynard, 97261 Fort-de-France, Martinique
| | - A Arrigo
- Department of neuroradiology, Pierre-Zobda-Quitman hospital, university hospital of Martinique, route de La Meynard, 97261 Fort-de-France, Martinique
| | - S Olindo
- Department of neurology, Pierre-Zobda-Quitman hospital, university hospital of Martinique, 97261 Fort-de-France, Martinique
| |
Collapse
|
16
|
Dieleman N, van der Kolk AG, Zwanenburg JJM, Brundel M, Harteveld AA, Biessels GJ, Visser F, Luijten PR, Hendrikse J. Relations between location and type of intracranial atherosclerosis and parenchymal damage. J Cereb Blood Flow Metab 2016; 36:1271-80. [PMID: 26661234 PMCID: PMC4929701 DOI: 10.1177/0271678x15616401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to assess the relation between location and type of intracranial atherosclerosis (ICAS) and cortical microinfarcts (CMIs) and macroinfarcts in 18 patients presenting with ischemic stroke (n = 12) or transient ischemic attack (TIA) (n = 6) using 7 tesla MR imaging. The protocol included: 3D T2-weighted FLAIR and 3D T1-weighted Magnetization-Preparation Inversion Recovery Turbo Spin Echo sequence. ICAS lesions and infarcts were scored by two raters. The relation between ICAS lesions, calculated ratios of ICAS lesion characteristics, location, and infarcts were examined using linear regression analyses. A total number of 75 ICAS lesions (all patients), 101 CMIs (78% of patients), and 31 macroinfarcts (67% of patients) were found. Seventy-six and sixty-five percent of the CMIs and macroinfarcts, respectively, were found in the same vascular territory as the ICAS lesions (p = 0.977, p = 0.167, respectively). A positive correlation existed between the number of macroinfarcts and CMIs (p < 0.05). In patients with macroinfarcts, we found more concentric (p < 0.01) and diffuse (p < 0.05) type of ICAS lesions. A high prevalence of brain tissue lesions, both macroinfarcts and CMIs, were found in patients with ICAS. Macroinfarcts were found to be related to specific ICAS lesion types. The type of ICAS lesion seems to be promising as a marker for ICAS patients at higher risk of future infarcts.
Collapse
Affiliation(s)
- Nikki Dieleman
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | | | - Jaco J M Zwanenburg
- Department of Radiology, University Medical Center Utrecht, the Netherlands Image Sciences Institute, University Medical Center Utrecht, the Netherlands
| | - Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Anita A Harteveld
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Geert J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Fredy Visser
- Department of Radiology, University Medical Center Utrecht, the Netherlands Philips Healthcare, Best, the Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
17
|
Kim SE, Lee BI, Kim SE, Shin KJ, Park J, Park KM, Kim HC, Lee J, Baek HJ, Jin SC, Ha SY. Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Borderzone Infarcts. Stroke 2016; 47:1548-54. [PMID: 27217507 DOI: 10.1161/strokeaha.115.012285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Fluid-attenuated inversion recovery vascular hyperintensities (FVHs) are seen in some cases with cerebral hemodynamic impairment and collateral flow. Because the worst outcomes of patients with borderzone infarcts were mainly correlated with impaired hemodynamics, the presence of FVH might provide another clue for predicting the prognosis of patients with borderzone infarcts. METHODS We reviewed 1377 consecutive patients with ischemic stroke. Cortical borderzone (CBZ) and internal borderzone infarcts were selected based on diffusion-weighted imaging. FVHs were defined as tubular- or serpentine-shaped hyperintensities in the subarachnoid space. We investigated the clinical significance of FVHs in borderzone-infarcted patients. RESULTS Among 87 patients with borderzone infarcts, the presence of FVH was observed in 30 (34.5%). We identified 62 patients with CBZ infarcts and 25 patients with internal borderzone infarcts. In the cases with CBZ infarcts, the initial National Institutes of Health Stroke Scale scores and the portions of nonfavorable outcome at 3 months in the FVH(+) group were significantly higher than in the FVH(-) group (P<0.05 and P<0.001, respectively). Unlike the cases with CBZ infarcts, there were no significant differences of these clinical features between the FVH(+) group and the FVH(-) group in the patients with internal borderzone infarcts. CONCLUSIONS The findings of FVH are associated with relatively severe clinical presentation and nonfavorable prognosis in patients with CBZ infarcts, but not in patients with internal borderzone infarcts. The presence of FVH may help to identify CBZ-infarcted patients who require close observation and hemodynamic control.
Collapse
Affiliation(s)
- Si Eun Kim
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Byung In Lee
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Sung Eun Kim
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Kyong Jin Shin
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - JinSe Park
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Kang Min Park
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Hyung Chan Kim
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Joonwon Lee
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Hye Jin Baek
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Sung-Cheol Jin
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.)
| | - Sam Yeol Ha
- From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.).
| |
Collapse
|
18
|
Bergui M, Castagno D, D’Agata F, Cicerale A, Anselmino M, Maria Ferrio F, Giustetto C, Halimi F, Scaglione M, Gaita F. Selective Vulnerability of Cortical Border Zone to Microembolic Infarct. Stroke 2015; 46:1864-9. [DOI: 10.1161/strokeaha.114.008194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/08/2015] [Indexed: 11/16/2022]
|
19
|
Landi D, Maggio P, Lupoi D, Palazzo P, Altamura C, Falato E, Altavilla R, Vollaro S, Coniglio AD, Tibuzzi F, Passarelli F, Silvestrini M, Pasqualetti P, Vernieri F. Cortical Ischemic Lesion Burden Measured by DIR Is Related to Carotid Artery Disease Severity. Cerebrovasc Dis 2014; 39:23-30. [DOI: 10.1159/000369292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background: Over time, exposure to cerebrovascular risk factors and carotid artery disease may cause multiple asymptomatic brain cortical and subcortical microinfarcts, which are commonly found at brain autopsy. So far, lack of convenient neuroimaging tools limited the investigation of grey matter ischemic damage in vivo. We applied the Double Inversion Recovery (DIR) sequence to explore the impact of carotid artery disease on intracortical ischemic lesion load in vivo, taking into account the impact of demographic characteristics and vascular risk factors. Methods: DIR was acquired in 62 patients with common cerebrovascular risk factors stratified in three groups according to carotid artery disease severity. Intracortical lesions scored on DIR (DIRlns) were classified by vascular territory, lobe and hemisphere. White matter hyperintensities (WMHs) volume was also quantified on Fluid Attenuated Inversion Recovery sequence (FLAIR). Results: Among demographic characteristics and cerebrovascular risk variables explored, General Linear Model indicated that age and carotid artery disease were significantly associated to DIRlns. After correcting for age, DIRlns load was found to be significantly dependent on carotid artery stenosis severity (F(2, 58) = 5.56, p = 0.006). A linear positive correlation between DIRlns and WMHs was found after correcting for age (p = 0.003). Conclusions: Carotid disease severity is associated with DIRlns accrual. Microembolism and impaired cerebral hemodynamics may act as physiopathological mechanisms underlying cortical ischemic damage. The role of other factors, such as small vessel disease and the possible interaction with carotid disease, remains to be further explored.
Collapse
|
20
|
Wang Y, Wang J. Clinical and imaging features in different inner border-zone infarct patterns. Int J Neurosci 2014; 125:208-12. [DOI: 10.3109/00207454.2014.921785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
21
|
Flowers HL, Silver FL, Fang J, Rochon E, Martino R. The incidence, co-occurrence, and predictors of dysphagia, dysarthria, and aphasia after first-ever acute ischemic stroke. JOURNAL OF COMMUNICATION DISORDERS 2013; 46:238-248. [PMID: 23642855 DOI: 10.1016/j.jcomdis.2013.04.001] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 03/25/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED Dysphagia, dysarthria and aphasia occur frequently following stroke. Our purpose was to identify the incidence, co-occurrence, and predictors of these impairments after first-ever ischemic stroke. We used the Registry of the Canadian Stroke Network's database (2003-2008) from one stroke center to identify a random sample of 250 patients with acute ischemic stroke confirmed by MR imaging. We further conducted a retrospective medical chart review. We established reliable data capture and identified the presence of the three impairments. We derived incidence and co-occurrence estimates along with 95% confidence intervals (CI) for dysphagia, dysarthria, and aphasia. We then computed odds ratios (OR) through logistic regression to identify predictors. Twenty-nine patient charts were not available for review. Estimates of the incidence of dysphagia, dysarthria, and aphasia were 44% (95% CI, 38-51), 42% (95% CI, 35-48) and 30% (95% CI, 25-37), respectively. The highest co-occurrence of any two impairments was 28% (95% CI, 23-34) for the presence of both dysphagia and dysarthria. Ten percent of all 221 patients had all three impairments. The highest predictors were non-alert level of consciousness for dysphagia (OR 2.6, CI 1.03-6.5), symptoms of weakness for dysarthria (OR 5.3, CI 2.4-12.0), and right-sided symptoms for aphasia (OR 7.1, CI 3.1-16.6). These findings are a first step toward identifying the incidence and predictors of multiple co-occurring impairments in a homogenous stroke sample. LEARNING OUTCOMES Learning outcomes: Readers will be able to (1) RECOGNIZE the need for research in stroke, whereby outcomes are reported according to stroke etiology and recurrence patterns, (2) identify the incidence and co-occurrence of dysphagia, dysarthria, and aphasia after a first-ever acute ischemic stroke, and (3) describe clinical precursors of these impairments in the acute stage of stroke.
Collapse
Affiliation(s)
- Heather L Flowers
- Department of Speech Language Pathology, University of Toronto, 160-500 University Avenue, Rehabilitation Sciences Building, Toronto, ON M5G 1V7, Canada.
| | | | | | | | | |
Collapse
|
22
|
Otiobanda GF, Ossou-Nguiet PM, Itoua C, Ndinga H, Chobli M. [Bilateral border zone infarct during spinal anaesthesia for caesarean section]. ACTA ACUST UNITED AC 2013; 32:207-8. [PMID: 23428619 DOI: 10.1016/j.annfar.2013.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
|