Recent Advances in Magnetic Resonance Imaging in Posterior Circulation Stroke: Implications for Diagnosis and Prognosis

Förster, Alex; Griebe, Martin; Gass, Achim; Hennerici, Michael G.; Szabo, Kristina

doi:10.1007/s11936-011-0119-8

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Macroscopic and microscopic anatomy of the posterior circulation differs significantly from the anterior circulation with regard to the supplying vessels (the vertebral arteries (VA) merge and form the single midline basilar artery), the higher frequency of congenital vessel variations (e.g. hypoplasia of the VA, fetal origin of the PCA), and the large variety of supplied anatomical structures (neocortex, allocortex, thalamus, brainstem, and cerebellum)[ 36 ]. Furthermore, differences in the prevalence of atherosclerosis risk factors [ 37 ] as well as differences in pathological changes such as vessel thickening, elastin loss, and concentric intimal thickening [ 38 ] between anterior and posterior circulation have been demonstrated only recently.…”

Section: Discussionmentioning

confidence: 99%

Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

et al. 2018

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ObjectivesVertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy associated with intracerebral hemorrhage. In the present study, we sought to evaluate the frequency and anatomical distribution of cerebral microbleeds (cMBs) and intracerebral hemorrhage (ICH) in VBD.MethodsFrom a MRI database 94 VBD patients were identified and analyzed with special emphasis on cMBs and ICH on T2*-weighted gradient echo images (GRE) in relation to the established diagnostic MRI criteria of VBD (diameter, height, and lateral position). cMBs/ICH location was categorized into anterior/posterior circulation. Clinical information like demographic details, clinical symptoms, and comorbidities were abstracted from the case records. An extensive modelling approach using generalized linear mixed-effects models was used.ResultsOverall, 79 (84.0%) patients (mean age 72.1±10.0 years, 74.7% male) with a standard stroke MRI protocol including T2*-weighted images were included in the analysis. cMBs were observed in 38/79 (48.1%) patients, ranging from 1 to 84 cMBs per patient. In the posterior circulation cMBs were observed more frequently (34/38 (89.5%)) in comparison to the anterior circulation (24/38 (63.2%)). cMBs were observed in the thalamus in 20/38 (52.6%), hippocampus in 1/38 (2.6%), occipital lobe in 18/38 (47.4%), pons in 6/38 (15.8%), medulla oblongata in 2/38 (5.2%), and cerebellum in 14/38 (36.8%) patients. ICH was observed in only 6/79 (7.6%) patients. There were significantly more cMBs in the posterior- (NCMBs-PC = 1.717, 95%CI: 1.336–2.208, p = 0.0315) than in the anterior circulation.Logistic regression model showed a significant positive effect of clinical symptoms such as ischemic, TIA and hemorrhagic stroke on the presence of cMBs (OR = 3.34, 95%CI [2.0–5.57], p = 0.0184; ndf = 78, AIC = 107.51).General linear model showed that clinical symptoms have a highly significant effect on the number of cMBs (N = 2.78, 95%CI [2.51–3.07], p<2*10–16; ndf = 78, AIC = 1218).ConclusioncMBs and ICH may be observed in the anterior and posterior circulation in VBD but they occur more frequently in the posterior circulation. Most common anatomical locations of cMBs in VBD were the thalamus, occipital lobe and cerebellum. This posterior dominance of cMBs and ICH in VBD might reflect a specific underlying vascular pathology.

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Section: Discussionmentioning

confidence: 99%

Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

et al. 2018

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“…Another advantage of MRI is in documentation of posterior circulation strokes [13]. Our previous study found that young adults with a posterior circulation infarct were more likely to be misdiagnosed [5].…”

Section: Discussionmentioning

confidence: 99%

Early use of MRI improves diagnostic accuracy in young adults with stroke

Bhattacharya

Nagaraja

Rajamani

et al. 2013

Journal of the Neurological Sciences

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“…Twenty to 30% of all ischaemic strokes occur in the territory of the vertebrobasilar (posterior) circulation, including the cerebellum (Bogousslavsky et al, 1993; Flossmann and Rothwell, 2003; Förster et al, 2011; Hong et al, 2009; Khan et al, 2007). Large cerebellar infarcts have traditionally been classified in function of affected arterial perfusion territories (Edlow et al, 2008; Caplan et al, 2005; Marinković et al, 1995; Hartkamp et al, 2013; Tatu et al, 1996), i.e.…”

Section: Introductionmentioning

confidence: 99%

Cerebellar infarct patterns: The SMART-Medea study

Cocker

Geerlings

Hartkamp

et al. 2015

NeuroImage: Clinical

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ObjectivePrevious studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of cerebellar infarcts presenting as an incidental finding on MRI.MethodsWe analysed the 1.5 Tesla MRI, including 3D T1-weighted datasets, of 636 patients (mean age 62 ± 9 years, 81% male) from the SMART-Medea study. Cerebellar infarct analyses included an assessment of size, cavitation and gliosis, of grey and white matter involvement, and of infarct topography.ResultsOne or more cerebellar infarcts (mean 1.97; range 1–11) were detected in 70 out of 636 patients (11%), with a total amount of 138 infarcts identified, 135 of which showed evidence of cavitation. The average mean axial diameter was 7 mm (range 2–54 mm), and 131 infarcts (95%) were smaller than 20 mm. Hundred-thirty-four infarcts (97%) involved the cortex, of which 12 in combination with subcortical white matter. No infarcts were restricted to subcortical branches of white matter. Small cortical infarcts involved the apex of a deep (pattern 1) or shallow fissure (pattern 2), or occurred alongside one (pattern 3) or opposite sides (pattern 4) of a fissure. Most (87%) cerebellar infarcts were situated in the posterior lobe.ConclusionsSmall cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.

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Recent Advances in Magnetic Resonance Imaging in Posterior Circulation Stroke: Implications for Diagnosis and Prognosis

Cited by 10 publications

References 34 publications

Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

Early use of MRI improves diagnostic accuracy in young adults with stroke

Cerebellar infarct patterns: The SMART-Medea study

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