High Signal Intensity on T2-Weighted Magnetic Resonance Imaging and Cerebral Hemodynamic Reserve in Carotid Occlusive Disease

Isaka, Yoshinari; Nagano, Keiko; Narita, Masako; Ashida, Keiichi; Imaizumi, Mitsuyoshi

doi:10.1161/01.str.28.2.354

Cited by 42 publications

(28 citation statements)

References 15 publications

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“…Perfusion studies have demonstrated that paraventricular white matter is most vulnerable to hemodynamic changes in patients with carotid artery occlusive disease. 32 The CBZ lies relatively closer to the cortical surface, where penetrating arteries originate, and has better chance for collateral supply through leptomeningeal and dural anastomoses, which makes it more resistant to decreased cerebral perfusion.…”

Section: Discussionmentioning

confidence: 99%

Internal and Cortical Border-Zone Infarction

Yong

Bang

Lee

et al. 2006

Stroke

125

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Background and Purpose-The pathogenesis of internal border-zone (IBZ) and cortical border-zone (CBZ) infarcts is unclear. Both types of infarct have been combined into a single group in most previous reports, which has produced conflicting results. We hypothesized that different pathogenic mechanisms underlie IBZ and CBZ infarcts. Methods-We reviewed 946 consecutive patients with ischemic stroke within the middle cerebral artery territory. IBZ and CBZ infarcts were selected based on diffusion-weighted imaging templates to identify vascular territories. Baseline patient characteristics, clinical courses, and neuroradiological features were compared between patients with IBZ and CBZ infarcts. Results-We identified 45 IBZ and 75 CBZ infarct patients. Compared with the CBZ infarct patients, IBZ infarct patients had a higher degree of stenosis or occlusion in either the middle cerebral or internal carotid artery (Pϭ0.008) and exhibited a rosary-like pattern of infarction more frequently (PϽ0.001). In contrast, concomitant small cortical infarcts were observed more frequently in CBZ infarct patients (PϽ0.001). Clinical deterioration during the first 7 days of admission and poor outcome after 3 months after stroke was more prevalent in IBZ infarct patients than in CBZ infarct patients (Pϭ0.002 and Pϭ0.003, respectively). Conclusions-IBZ

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Section: Discussionmentioning

confidence: 99%

Internal and Cortical Border-Zone Infarction

Yong

Bang

Lee

et al. 2006

Stroke

125

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“…45 The development of small infarcts within the IWS could be followed also by diffusion-weighted magnetic resonance imaging. 46 Patients with IWS infarcts had higher degrees of occlusive vascular disease and showed more severe early and late clinical course than those with CWS infarcts. 33 Only a few studies found some hints for additional embolic events within the hemodynamically compromised IWS.…”

Section: Neuroimagingmentioning

confidence: 88%

History of the Letzte Wiese/Last Meadow Concept of Brain Ischemia

Hossmann

Heiss

2016

Stroke

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“…shown to the right) in 2 patients with typical rosary-like deep watershed infarcts, illustrating opposite scenarios. In patient 12 (top row), the MTT is higher in the symptomatic (left) hemisphere (arrows) in the absence of microembolic signals on TCD, whereas in patient 3 (bottom row) no significant MTT changes are seen in the symptomatic (right) hemisphere whereas microembolic signals were present on TCD (see Table 1 Studies addressing DWS infarction, 3 specifically those arranged in a rosary-like pattern, [5][6][7][8][9][10] have suggested a strong association with HDI. There is, however, discrepant evidence from 1 large PET study, 11 as well as from 3 other imaging studies with lesser focus on DWS infarcts.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 In contrast, hemodynamic impairment (HDI) is strongly associated with deep watershed (DWS) infarcts, 3 especially when they adopt a rosary-like pattern in the centrum semiovale (CSO). [5][6][7][8][9][10] However, 1 positron emission tomography (PET) study 11 suggested a microembolic mechanism, among other possibilities. Several factors may explain this discrepancy.…”

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confidence: 99%

Microembolism Versus Hemodynamic Impairment in Rosary-Like Deep Watershed Infarcts

Moustafa

Momjian-Mayor

Jones

et al. 2011

Stroke

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Background and Purpose-Deep watershed infarcts are frequent in high-grade carotid disease and are thought to result from hemodynamic impairment, particularly when adopting a rosary-like pattern. However, a role for microembolism has also been suggested, though never directly tested. Here, we studied the relationships among microembolic signals (MES) on transcranial Doppler, rosary-like deep watershed infarcts on brain imaging, and cerebral hemodynamic compromise on positron emission tomography (PET), all in severe symptomatic carotid disease. We hypothesized that rosary-like infarcts would be significantly associated with worse hemodynamic status, independent of the presence of MES. Methods-Sixteen patients with Ն70% carotid disease ipsilateral to recent transient ischemic attack/minor stroke underwent magnetic resonance imaging including diffusion-weighted imaging,

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High Signal Intensity on T2-Weighted Magnetic Resonance Imaging and Cerebral Hemodynamic Reserve in Carotid Occlusive Disease

Abstract: The centrum semiovale T2 hyperintensities lateralized to the side of carotid occlusion are specific and sensitive for the presence and severity of hemodynamic compromise from carotid occlusive disease.

Cited by 42 publications

References 15 publications

Internal and Cortical Border-Zone Infarction

Internal and Cortical Border-Zone Infarction

History of the Letzte Wiese/Last Meadow Concept of Brain Ischemia

Microembolism Versus Hemodynamic Impairment in Rosary-Like Deep Watershed Infarcts

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