A diffusion-weighted MRI study of acute ischemic distal arm paresis

Gass, Achim; Szabo, Kristina; Behrens, Stephan; Roßmanith, Christina; Hennerici, Michael G.

doi:10.1212/wnl.57.9.1589

Cited by 76 publications

(43 citation statements)

References 24 publications

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“…This pattern is consistent with the infarct location involving the hand and face areas of the homunculus [27, 35]. Occasionally, subtle deficits such as expressive aphasia alone or mild arm paresis were seen.…”

Section: Discussionsupporting

confidence: 82%

Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?

et al. 2009

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Background and Purpose: We have noted the presence of small strip-like infarcts involving the cortex within the interdivisional territory of the middle cerebral artery (MCA) and sometimes extending to the periventricular region. The incidence in a stroke unit population, mechanisms, clinical expression and prognosis of patients with these cortical infarcts are unknown. To clarify these issues we retrospectively and prospectively identified these patients in our own stroke unit population. Methods: Patients were identified retrospectively and prospectively from the Austin Hospital Stroke Unit from March 2001 to May 2007. All were selected on the basis of the recent onset of an acute neurological deficit with imaging showing strip infarction within the MCA territory. Clinical features were recorded and the mechanism of infarction was classified based on the TOAST criteria from standard investigations. Results: From 4,274 acute stroke admissions, there were 24 patients (0.6%), 12 males and 12 females (mean age 75 years; range 44–92 years) with CT or MRI showing characteristic linear infarction in the middle cerebral territory. In most cases, infarction was adjacent to the central sulcus. Common clinical features included mild-to-moderate hemiparesis with cortical signs. The most common TOAST criterion mechanism categories were artery-to-artery or cardiac embolism. It is postulated that this resulted in either isolated small cortical artery branch occlusion or borderzone infarction between superior and inferior divisions of the MCA due to more proximal large-artery vessel occlusion. Prognosis was good. Conclusions: We describe the phenotypic expression, postulated mechanisms and prognosis of strip-like infarcts between the superior and inferior MCA divisions. The likely artery-artery or cardio-embolic mechanisms should prompt clinicians to search for an embolic source. While the prognosis of the syndrome is generally good, its recognition may allow specific therapies to be developed to improve clinical outcomes further.

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Section: Discussionsupporting

confidence: 82%

Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?

et al. 2009

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“…These silent lesions obviously represent morphological brain damage 6 and, if located in an eloquent brain area such as the internal capsule or the precentral gyrus, contralateral hemiparesis may be caused despite a small lesion size. 24 It can be anticipated that in a cohort of patients larger than the present study groups, symptomatic ischemia caused by small ischemic lesions would be likely.…”

Section: Bendszus Et Al Heparin and Air Filters Reduce Embolic Eventsmentioning

confidence: 83%

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

et al. 2004

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Background-Intra-arterial cerebral angiography is associated with a low risk for neurological complications, but clinically silent ischemic events after angiography have been seen in a substantial number of patients. Methods and Results-In a prospective study, diffusion-weighted magnetic resonance imaging (DW-MRI) before and after intra-arterial cerebral angiography and transcranial Doppler sonography during angiography were used to evaluate the frequency of cerebral embolism. One hundred fifty diagnostic cerebral angiographies were randomized into 50 procedures, each using conventional angiographic technique, or systemic heparin treatment throughout the procedure, or air filters between the catheter and both the contrast medium syringe and the catheter flushing. There was no neurological complication during or after angiography. Overall, DW-MRI revealed 26 new ischemic lesions in 17 patients (11%). In the control group, 11 patients showed a total of 18 lesions. In the heparin group, 3 patients showed a total of 4 lesions. In the air filter group, 3 patients exhibited a total of 4 lesions. The reduced incidence of ischemic events in the heparin and air filter groups compared with the control group was significantly different (Pϭ0.002).Transcranial Doppler sonography demonstrated a large number of microembolic signals that was significantly lower in the air filter group compared with the heparin and control groups (PϽ0.01), which did not differ from each other. Conclusions-Air filters and heparin both reduce the incidence of silent ischemic events detected by DW-MRI after intra-arterial cerebral angiography and can potentially lower clinically overt ischemic complications. This may apply to any intra-arterial angiographic procedure.

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“…The most exact clinical description given by The Earl of Shaftesbury who reports a ‘palsy [that] took entirely away the use of 4 fingers of his right hand and totally disabled him from playing’ occurred in 1737. This is worth a closer look, because a clinical pattern like this may well be caused by a small emboligenic stroke in the cortical hand knob, as depicted and published in the magnetic resonance imaging era, and which usually has a very benign course [14, 15]. …”

Section: Etiologymentioning

confidence: 99%

Georg Friedrich Händel’s Strokes

Bäzner

Hennerici

2004

Cerebrovasc Dis

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Georg Friedrich Händel was a musical giant and probably the first composer to be the manager and promoter of his own works. The story of his life and illnesses is full of myths, invented and embellished by various biographies. Existing pathographies written by authors from various specialities suggested he suffered from psychiatric diseases like cyclothymia or mania and rheumatologic disorders like arthritis, while others tended to interpret his recurrent palsies as typical sequelae of ischemic strokes. During the last years of life, Händel was struck with blindness, which in his era was interpreted as being due to cataracts. This led to three ‘coucher’ operations, all of them without lasting effect. Although a definite diagnosis cannot be inferred from the original sources, the most plausible explanation for Händel’s palsies and visual impairment may be cerebrovascular disease. The possible differential diagnosis will be discussed in this paper.

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A diffusion-weighted MRI study of acute ischemic distal arm paresis

Cited by 76 publications

References 24 publications

Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?

Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?

Heparin and Air Filters Reduce Embolic Events Caused by Intra-Arterial Cerebral Angiography

Georg Friedrich Händel’s Strokes

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