Cerebral border zone infarction: an etiological study

El-Gammal, Tarek Mohammed; Bahnasy, Wafik Said; Al-Malt, Ayman M.

doi:10.1186/s41983-018-0008-0

Cited by 8 publications

(6 citation statements)

References 22 publications

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“…In contrast, septic shock-related stroke tends to manifest as a cortical border zone infarction with a large infarct area. According to a previous study, cardiogenic or major artery-derived embolism plays a crucial role in the pathogenesis of external border zone infarcts, which are less frequently associated with hemodynamic compromise ( 29 , 30 ). In our cohort, some patients with septic shock manifested as both internal and external zone infarcts, the mechanism of which was thought to be systemic hypoperfusion concomitant with artery-to-artery embolism ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

Sha

Han²,

Hong³

et al. 2023

Front. Neurol.

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ObjectiveTo determine the etiology spectrum and lesion distribution patterns of patients with acute multiple infarcts in multiple cerebral territories (AMIMCT) and provide guidance for treatment and prevention strategies in these patients.MethodsPatients with acute ischemic stroke diagnosed using diffusion-weighted imaging (DWI) were consecutively included in this study between June 2012 and Apr 2022. AMIMCT was defined as non-contiguous focal lesions located in more than one cerebral territory with acute neurological deficits. We retrospectively analyzed the clinical and imaging characteristics, etiology spectra and underlying mechanisms in patients with and without AMIMCT. Infarct lesion patterns on DWI and their relevance to etiology were further discussed.ResultsA total of 1,213 patients were enrolled, of whom 145 (12%) were diagnosed with AMIMCT. Patients with AMIMCT tended to be younger (P = 0.016), more often female (P = 0.001), and exhibited less common conventional vascular risk factors (P < 0.05) compared to those without AMIMCT. The constitution of the Trial of Org 10,172 in Acute Stroke Treatment classification was significantly different between patients with and without AMIMCT (P = 0.000), with a higher proportion of stroke of other determined causes (67.6% vs. 12.4%). For detailed etiologies, autoimmune or hematologic diseases were the most common (26.2%) etiologies of AMIMCT, followed by periprocedural infarcts (15.2%), cardioembolism (12.4%), tumor (12.4%), large artery atherosclerosis (10.3%), and sudden drop in blood pressure (8.3%). Hypercoagulability and systemic hypoperfusion are common underlying mechanisms of AMIMCT. Distinctive lesion distribution patterns were found associated with stroke etiologies and mechanisms in AMIMCT. Most of patients with large artery atherosclerosis (73.3%), autoimmune/hematologic diseases (57.9%) manifested the disease as multiple infarct lesions located in bilateral supratentorial regions. However, 66.7% of cardioembolism and 83.8% of cardiovascular surgery related stroke presented with both supratentorial and infratentorial infarct lesions.ConclusionThe etiologies and mechanisms of patients with AMIMCT were more complex than those without AMIMCT. The distribution characteristics of infarct lesions might have important implications for the identification of etiology and mechanism in the future, which could further guide and optimize clinical diagnostic strategies.

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Section: Discussionmentioning

confidence: 99%

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

Sha

Han²,

Hong³

et al. 2023

Front. Neurol.

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“…Border zone infarction (BZI) occur at the anastomotic watershed areas of two main arteries [ 8 ]. This type of infarction accounts for about 10% of all CI [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Hemophilia A developing cerebral infarction after surgical treatment of giant hemophilic pseudotumor: a case report

Ling

Shi

et al. 2022

BMC Surg

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Background Cerebral infarction (CI) is an unusual complication in patients with bleeding disorders. To our knowledge, this is the first case of postoperative internal border-zone infarction (I-BZI) from Hemophilia A. Case presentation We present a case of Hemophilia A developing I-BZI, after surgical treatment of giant hemophilic pseudotumor. A 36-year-old man was introduced from other hospital by Hemophilia with giant hemophilic pseudotumor in his left thigh. Patient and his relatives did not have a history of thrombophilia. After excluding the relevant surgical contraindications, we performed the operation of pseudotumor resection. Prior to surgery, blood tests revealed hemoglobin of 137 g/L. FVIII activity was 1.5%. Activated partial thromboplastin time (APTT) was 71.50 s and D-dimer was 3.33 mg/L FEU. Immediately before surgery, the patient received an intravenous infusion of FVIII products (Xyntha®) at a dose of 3500 IU for his body weight of 80 kg. Post-operative day two (POD2), patient developed vomiting, decreased response, and dysarthria. Hemoglobin was 54 g/L with blood pressure of 110/70 mmHg. Magnetic resonance imaging of the brain showed there were multiple acute cerebral infarctions in bilateral lateral ventricles (internal border zone) and multiple ischemic foci in the white matter areas and basal ganglia of the bilateral cerebral hemispheres. This case suggested that acute severe anemia can be one of the causes of I-BZI. Conclusions For the treatment of I-BZI caused by acute anemia from Hemophilia A, volume expansion, red blood cell supplement and continuous improvement of coagulation with suitable dose of factor VIII (FVIII) should be considered to improve prognosis.

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“…In their study, patients with cortical watershed infarction had a lower rate of vascular stenosis; i.e., CT angiography did not show a significant difference in the rate of large vessel stenosis in the external watershed infarction group compared to the control group. 22 In a study by Dong et al, vascular risk factors in patients with BZI were evaluated. 23 In the internal BZI group, there was a higher degree of stenosis or obstruction of MCA and carotid arteries on the same side and MCA on the opposite side compared to the non-watershed infarction group, with no significant difference in stenosis or obstruction of large arteries compared to the non-watershed infarction group.…”

Section: Discussionmentioning

confidence: 99%

Cerebral border zone infarctions: An etiologic study

Hashemilar¹,

Tohidi²,

Forghani³

et al. 2022

CJN

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Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients. Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system. Results: The study included 106 patients with BZI, 53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction. Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.

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Cerebral border zone infarction: an etiological study

Cited by 8 publications

References 22 publications

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories

Hemophilia A developing cerebral infarction after surgical treatment of giant hemophilic pseudotumor: a case report

Cerebral border zone infarctions: An etiologic study

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