Correlation of CT cerebral vascular territories with function: I. Anterior cerebral artery

Berman, SA; Hayman, L. Anne; Vc, Hinck

doi:10.2214/ajr.135.2.253

Cited by 76 publications

(33 citation statements)

References 16 publications

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“…4 -5,1 '. Lesions were classified as situated in one of the following vascular territories: anterior cerebral artery ; middle cerebral artery; posterior cerebral artery; internal carotid artery (anterior + middle cerebral arteries); hemispheric infarction; and watershed.…”

Section: Methodsmentioning

confidence: 99%

The correlation of ct findings and in-hospital mortality after cerebral infarction

André¹,

Pinheiro

1995

Arq. Neuro-Psiquiatr.

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SUMMARY -Objective:To evaluate whether findings on computed tomography (CT) are useful to predict early mortality after acute cerebral infarction. Methods: An admission CT was performed in 98 patients with disease-onset within 7 days; CT findings were analyzed using a checking list; their influence on hospital mortality was studied by logistic regression analysis. Results: There were 29 hospital deaths. Uncal herniation and midline shift>4mm were strongly correlated with fatal outcome. Also associated with increased mortality: infarction of a whole hemisphere or in the distribution of internal carotid artery; massive (>90% expected area) infarction in the territory of the anterior or posterior cerebral arteries; massive or submassive (>50% expected area) middle cerebral artery infarction; large lesion volume (death in 9/13 patients with lesions >50cm 3 ); any degree of mass effect. In 68 patients with single middle cerebral artery lesions, extension of the lesion to adjacent vascular territories was also associated with a worse outcome. The number of lesions and the presence of contrast enhancement, hemorrhagic changes or cerebral atrophy did not influence outcome. Conclusions: CT findings indicating significant mass effect and large infarcts are associated with mortality after ischemic stroke. The best combination of clinical and CT variables to estimate death risk in individual patients remains to be determined.KEYWORDS: cerebral infarction, cerebrovascular disorders, cerebral hernia, mortality, prognosis, CT scan.Correlação entre achados à TC e letalidade hospitalar após infarto cerebral RESUMO -Objetivo: Avaliar a importância dos achados à tomografia computadorizada (TC) na determinação do risco de vida precoce após o infarto cerebral. Métodos: 98 pacientes com infarto cerebral com até 7 dias de evolução foram estudados por TC à admissão; os achados à TC foram avaliados de modo padronizado; a influência destes achados sobre a letalidade hospitalar foi estudada por análise de regressão logística. Resultados: 29 pacientes faleceram durante a internação. Herniação de unco e desvio de estruturas de linha média superior a 4 mm associaram-se fortemente ao risco de vida elevado. Outros fatores positivamente relacionados: infarto hemisférico ou ocupando o território carotídeo (a. cerebral anterior e a. cerebral média); infarto maciço (>90% da área esperada) no território das artérias cerebrais anterior ou posterior; infarto maciço ou submaciço (>50% da área esperada) no território da artéria cerebral média; grande volume de lesão (morte em 9/13 pacientes com lesão >50cm 3 ); qualquer grau de efeito de massa. Em 68 pacientes com lesões únicas no território da artéria cerebral média, a extensão da lesão a territórios vasculares adjacentes também associou-se a pior prognóstico. O número de lesões e a presença de captação de contraste, transformação hemorrágica ou de atrofia cerebral não influenciaram a evolução. Conclusões: Os achados de importante efeito de massa e grandes lesões à TC associamse fortemente a alta leta...

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Section: Methodsmentioning

confidence: 99%

The correlation of ct findings and in-hospital mortality after cerebral infarction

André¹,

Pinheiro

1995

Arq. Neuro-Psiquiatr.

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“…Lacunar infarcts were defined as lesions 3 to 9 mm in diameter on T1-weighted images, located in the deep WM or basal ganglia and supplied by the deep branches of anterior (ACA), middle (MCA), or posterior (PCA) cerebral arteries or internal carotid artery (ICA). [27][28][29][30] Border-zone infarcts were located in the vascular border zone between ACA, MCA, or PCA or between the superficial and deep branches of cerebral arteries. Infarcts affecting the corticosubcortical layers of cerebral hemispheres in the territories of superficial branches of ACA, MCA, and PCA were classified as cortical.…”

Section: Infarct Subtypesmentioning

confidence: 99%

Magnetic Resonance Imaging White Matter Hyperintensities and Mechanism of Ischemic Stroke

Mäntylä¹,

Aronen²,

Salonen³

et al. 1999

Stroke

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Background and Purpose-We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI. Materials and Methods-We studied 395 ischemic stroke patients with 1.0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts. Results-Lacunar

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“…Although a wedgeshaped infarction on empirical grounds suggests a hemodynamic pathogenesis, the primary cause is indicated as thromboembolic when the infarct is not located in one of the well-known border zones. Many templates and diagrams of the territories of the six major cerebral arteries-the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries on both sides-provide a guide in making this diagnosis 1 …”

Section: S Ince the Introduction Of Computed Tomographymentioning

confidence: 99%

Review of the variability of the territories of the major cerebral arteries.

Zwan

Hillen

1991

Stroke

104

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The results of recent model studies indicate that the variability in territorial distribution of the major cerebral arteries may be much greater than has been previously recognized. We review the literature on the cortical and intracerebral territories of the anterior, middle, and posterior cerebral arteries. Although most authors claim that these territories are relatively consistent, the results of their studies show many and considerable discrepancies. The variability described by Beevor has been neither excluded nor completely confirmed, yet somehow the concept of a relatively unchanging pattern of the peripheral cerebral vascularization has gradually settled into the literature. We discuss the considerable variability of the cerebral territories, as well as the discrepancies in investigation techniques, injection materials, and specimen conditions that could be factors producing these dissimilar results. Our study shows that there are no arguments in the literature to negate the variability of the cerebral territories. (Stroke 1991;22:1078-1084) S ince the introduction of computed tomography into neuroradiologic practice, the differential diagnosis of hemodynamic watershed infarction and thromboembolic ischemia is largely based on the location of the visualized infarct. Although a wedgeshaped infarction on empirical grounds suggests a hemodynamic pathogenesis, the primary cause is indicated as thromboembolic when the infarct is not located in one of the well-known border zones. Many templates and diagrams of the territories of the six major cerebral arteries-the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries on both sides-provide a guide in making this diagnosis 1 " 5 and are based on the concept of a symmetrical and negligibly variable territorial distribution.This concept is also used in experimental models designed to investigate the hemodynamic behavior of the circle of Willis. In these models, the ratio of the vascular resistance of the six major cerebral arteries is an important parameter, 6 -11 yet the literature provides no accurate data on the in vivo peripheral resistance of these vessels. Thus, the ratio of resistance is estimated, based on the assumption that the peripheral resistance of the six major cerebral arteries is inversely proportional to the brain mass irrigated by each vessel.10 Because the variability of the territorial distribution is described in the literature as Received October 17, 1990; accepted April 23, 1991. relatively small in contrast to the large variability of the circle of Willis, the ratio of the peripheral resistance of the six major cerebral arteries is considered to be invariant in all models. However, the mathematical model of Hillen et al 11 and statistical analysis of the diameters of various segments of the circle of Willis 12 -13 indicate that within the circle a significant relationship exists between blood flow and vessel size. Considering the large variability of the proximal diameters of the major cerebral arteries (coefficients of v...

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Correlation of CT cerebral vascular territories with function: I. Anterior cerebral artery

Abstract: This wo rk was suppo rt ed in part by EMt M ed. tnc .

Cited by 76 publications

References 16 publications

The correlation of ct findings and in-hospital mortality after cerebral infarction

The correlation of ct findings and in-hospital mortality after cerebral infarction

Magnetic Resonance Imaging White Matter Hyperintensities and Mechanism of Ischemic Stroke

Review of the variability of the territories of the major cerebral arteries.

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