Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging

Araúz, Antonio; Murillo, Luis; Cantú, Carlos; Barinagarrementería, Fernando; Higuera, Jesús

doi:10.1161/01.str.0000090351.41662.91

Cited by 103 publications

(69 citation statements)

References 60 publications

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“…Although never-symptomatic carotid artery occlusions were reported to carry a very low risk of subsequent ischemic stroke due to a low incidence of increased oxygen extraction fraction (35), it is well known that large-artery arteriosclerosis confers an increased risk of stroke recurrence (36). In fact, stroke recurrence is greater in patients with multiple lacunar infarcts compared to those with only one lacunar infarct (37). This corresponds to the clinical observation that patients who have suffered a TIA have a high risk of subsequent stroke, death, or disability (38).…”

Section: Discussionmentioning

confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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Purpose: To determine whether the perfusion deficit could predict brain infarction in patients with chronic cerebral ischemia who experienced recurring episodes of neurological symptoms and showed a perfusion-diffusion mismatch on magnetic resonance (MR) images. Materials and Methods:In 53 consecutive patients (38 males and 15 females, 62 Ϯ 13 years old) with ischemia in the middle cerebral artery (MCA) territory, lesion volumetry was performed on parametric maps of the time-to-peak, the cerebral blood volume, and diffusion-weighted (DW) images. The infarct lesions were assessed on follow-up T2-weighted (T2W) MR images after eight days. Cerebrovascular changes were determined by time-of-flight (TOF) MR angiography (MRA). Inferential and correlation statistics were used. Results:Patients with chronic ischemic brain disease (N ϭ 39) who presented with a severe perfusion-diffusion mismatch in the presence of a normal cerebral blood volume had no or small brain infarctions as found on follow-up T2W images. MRA revealed widespread abnormalities of the basal cerebral arteries compatible with brain perfusion abnormalities. In contrast, in acute stroke patients (N ϭ 14) the deficit of cerebral perfusion predicted the infarct lesion in the T2W images. Conclusion:Our results suggest that in chronic cerebral ischemia the normal blood volume was maintained despite the depression of cerebral perfusion and recurring minor insults.

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Section: Discussionmentioning

confidence: 99%

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Surikova

Meisel

Siebler

et al. 2006

Magnetic Resonance Imaging

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“…Of the 12 studies categorized as "vascular cohorts," 1 showed a significant association between diabetes and silent lacunar infarcts (27) and 4 between diabetes and symptomatic lacunar infarcts (28 -31). Of the four studies categorized as "outpatient cohorts," one showed a significant association between diabetes and silent lacunar infarcts (22).…”

Section: Van Harten and Associatesmentioning

confidence: 99%

Brain Imaging in Patients With Diabetes

et al. 2006

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“…They are typically characterised by a regular shape that is frequently rounded or tube-like with a diameter of 0.2 -2 cm [11][12][13]. SSI account for up to 25% of all strokes [14] and occur predominantly in patients with small vessel disease, such as diabetes and hypertension [10].…”

Section: Introductionmentioning

confidence: 99%

“…There have been only a few MRI studies of small subcortical infarcts [14,[16][17][18][19][20][21][22][23][24]. Only smaller than the DWI lesion [21].…”

Section: Introductionmentioning

confidence: 99%

Inverse mismatch and lesion growth in small subcortical ischaemic stroke

et al. 2010

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OBJECTIVE: Infarction typically develops within the borders of an initial hypoperfused tissue. We prospectively investigated whether in small subcortical stroke patients infarct growth can occur beyond the margins of the affected vascular territories. METHODS: In 19 consecutive patients, stroke MRI was performed within 14 h after ictus, and at days 2 and 6 (± 1). Size of diffusion and perfusion disturbances were determined. Infarct volume measured on T2-weighted images on day 6 was considered as imaging endpoint. RESULTS: At the initial examination, the mean diffusion lesion [apparent diffusion coefficient (ADC) lesion size, 1.82 ± 1.2 ml] was larger (p = 0.0002) than the perfusion lesion [mean transit time (MTT) lesion size, 0.72 ± 0.69 ml]. Such an "inverse mismatch" (ADC lesion > MTT lesion) was present in 14/19 patients at baseline and in all patients on day 2. Final lesion volume at day 6 was 3.2 ± 1.6 ml which was larger than the initial perfusion deficit (p = 0.02). CONCLUSION: In small subcortical ischaemic stroke "inverse mismatch" is frequent and infarction develops beyond the initial perfusion disturbance. This indicates that cytotoxic processes probably triggered by the infarct core are a dominant mechanism for lesion growth. Areas with normal perfusion but which are threatened by cytotoxic damage developing over several days seem prime targets for neuroprotective therapy. We prospectively investigated whether in small subcortical stroke patients infarct growth can occur beyond the margins of the affected vascular territories.Methods: In 19 consecutive patients, stroke MRI was performed within 14 hours after ictus, and at days 2 and 6 (±1). Size of diffusion and perfusion disturbances were determined.Infarct volume measured on T2-weighted images on day 6 was considered as imaging endpoint.Results: At the initial examination, the mean diffusion lesion (ADC lesion size: 1.82±1.2 ml) was larger (p=0.0002) than the perfusion lesion (MTT lesion size: 0.72±0.69ml). Such an "Inverse Mismatch" (ADC lesion > MTT lesion) was present in 14/19 patients at baseline and in all patients on day 2. Final lesion volume at day 6 was 3.2±1.6ml which was larger than the initial perfusion deficit (p=0.02).Conclusion: In small subcortical ischaemic stroke "Inverse Mismatch" is frequent and infarction develops beyond the initial perfusion disturbance, This indicates that cytotoxic processes probably triggered by the infarct core are a dominant mechanism for lesion growth.Areas with normal perfusion but which are threatened by cytotoxic damage developing over several days seem prime targets for neuroprotective therapy.2

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Prospective Study of Single and Multiple Lacunar Infarcts Using Magnetic Resonance Imaging

Cited by 103 publications

References 60 publications

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Significance of the perfusion‐diffusion mismatch in chronic cerebral ischemia

Brain Imaging in Patients With Diabetes

Inverse mismatch and lesion growth in small subcortical ischaemic stroke

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