Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion

Abstract

Background and purposeIndividuals with intracranial artery occlusion have high rates of ischaemic events and recurrence. It has been challenging to identify patients who had high-risk stroke using a simple, valid and non-invasive screening approach. This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), a specific imaging sign on the FLAIR sequence, could be a predictor of ischaemic events in a population with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.MethodsWe retrospectively analysed 147 patients (mean 60.43±12.83 years) with 149 lesions, including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion. Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days. FVH Alberta Stroke Program Early Computed Tomography Score (FVH-ASPECTS: 0–7, with 0 indicating absence of FVH and 7 suggesting prominent FVH) and collateral circulation grade were assessed for each participant. Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status.ResultsA lower FVH-ASPECTS was associated with a more favourable collateral circulation grade (rho=−0.464, p<0.0001). The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group (p<0.0001). FVH-ASPECTS (Odd ratio, 2.973; 95% confidence interval, 1.849 to 4.781; p<0.0001) was independently associated with symptomatic status after adjustment for age, sex, lesion location and collateral circulation grade in the multivariate logistic regression. The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion.ConclusionsThe ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke. As a simple imaging sign, FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.

Schizencephaly: Etiopathogenesis, Classification, Therapeutic, and Rehabilitative Approach

“…exposure to teratogens such as narcotic substances, medications drugs (e.g., warfarin), or alcohol; viral infection, especially congenital cytomegalovirus infection; intrauterine fetal stroke, hypothesis supported by the frequent localization in the region of the lateral sulcus, corresponding to the vascularization area of the middle cerebral artery [13][14][15][16][17][18] ; maternal factors, such as young age (< 20 years), trauma, attempted abortion, invasive procedures for prenatal diagnosis, and lack of prenatal care. Schizencephaly is frequently described in abandoned or adopted children.…”

“…intrauterine fetal stroke, hypothesis supported by the frequent localization in the region of the lateral sulcus, corresponding to the vascularization area of the middle cerebral artery 13 14 15 16 17 18 ;…”

FLAIR vascular hyperintensity combined with asymmetrical prominent veins in acute anterior circulation ischemic stroke: prediction of collateral circulation and clinical outcome

“…FVH could serve as an objective basis for the formation of leptomeningeal collateral circulation after stroke [ 9 ]. Many studies have confirmed that FVH was correlated with circulation as well as the severity of hemodynamic impairments, opening up a new idea of exploring noninvasive assessment of the status of intracranial collaterals and prognosis [ 10 – 12 ].…”