Surgical Revascularization Reverses Cerebral Cortical Thinning in Patients With Severe Cerebrovascular Steno-Occlusive Disease

Fierstra, Jorn; MacLean, David B.; Fisher, Joseph A.; Han, Jay; Mandell, Daniel M.; Conklin, John; Poublanc, Julien; Crawley, Adrian; Regli, Luca; Mikulis, David J.; Tymianski, Michael

doi:10.1161/strokeaha.110.608521

Cited by 65 publications

(56 citation statements)

References 42 publications

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“…We can speculate that a better perfusion of the previously hypoperfused left pre-motor area may have lead to functional and structural changes that are a likely explanation for the increased activation on the fMr images and for the apparently increased gray matter thickness. as previously reported by Fierstra et al, 39 the reversal of a steal phenomenon can be paralleled by an increase in cortical thickness following therapeutic revascularization of steno-occlusive disease. Whether in our case the cortical thickness changes are the basis for or the consequence of the clinical improvement is debatable.…”

Section: Discussionsupporting

confidence: 80%

Brain Reorganization after Endovascular Treatment in a Patient with a Large Arteriovenous Malformation: The Role of Diagnostic and Functional Neuroimaging Techniques

et al. 2013

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We describe a case of brain cortical reorganization after embolization of a large right temporal arteriovenous malformation. A comprehensive imaging protocol, including functional magnetic resonance imaging (fMRI), cortical thickness analysis and 320-row computed tomography (CT) perfusion was used to provide information on brain plasticity and potential steal phenomenon. A 25-year-old man known for a right temporal grade V Spetzler-Martin classification arteriovenous malformation (AVM) presented with left progressive hemiparesis. He underwent functional 3T magnetic resonance imaging (fMRI), cortical thickness analysis, and CT perfusion (CT 320 row, Aquilion ONE, Toshiba, Tokyo, Japan) before and after endovascular treatment. The results were compared to look for modifications in brain perfusion and organization. An improvement in the left hemiparesis and a reorganization of motor function were observed after endovascular treatment. Modifications in the angioarchitecture and perfusion of an extensive AVM may be accompanied by a functional and structural reorganization of the brain. The location in the so-called eloquent regions may not be sufficient to explain the wide spectrum of symptoms that these patients can present. A more comprehensive approach considering a global involvement of the brain in patients with large AVMs is suggested to achieve the best treatment strategy and to stage treatment in incurable AVMs.

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Section: Discussionsupporting

confidence: 80%

Brain Reorganization after Endovascular Treatment in a Patient with a Large Arteriovenous Malformation: The Role of Diagnostic and Functional Neuroimaging Techniques

et al. 2013

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“…This anatomic alteration seems to be, at least partially, reversible after surgical revascularization. 27 Our study has several limitations. To evaluate cognitive performance, we used the MMSE that is usually considered as a screening test of global cognitive function.…”

Section: Discussionmentioning

confidence: 91%

Cognitive Deterioration in Bilateral Asymptomatic Severe Carotid Stenosis

Buratti

Balucani

Viticchi

et al. 2014

Stroke

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Background and Purpose-This study aimed to monitor cognitive performance during a 3-year period in subjects with bilateral asymptomatic severe internal carotid artery stenosis and to explore the role of cerebral hemodynamics and atherosclerotic disease in the development of cognitive dysfunction. Methods-One hundred fifty-nine subjects with bilateral asymptomatic severe internal carotid artery stenosis were included and prospectively evaluated for a 3-year period. At entry, demographics, vascular risk profile, and pharmacological treatments were defined. Cognitive status was evaluated using the Mini-Mental State Examination at baseline and at follow-up. Cerebral hemodynamics was assessed by transcranial Doppler-based breath-holding index test. As a measure of the extent of systemic atherosclerotic disease, common carotid artery intima-media thickness was measured. A cutoff for pathological values was set at 0.69 for breath-holding index and 1.0 mm for intima-media thickness.

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“…It has also been demonstrated that loss of cerebrovascular reactivity is an indication for surgical revascularization and that such treatments reduce the incidence of cerebral injury. 58 Thus, demonstration of a reduction in CVR in sickle cell patients may be a means of predicting children at risk of subsequent cerebral injury.…”

Section: Discussionmentioning

confidence: 99%

Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice

Cahill

Gazdzinski

Tsui

et al. 2016

J Cereb Blood Flow Metab

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Cerebral ischemia is a significant source of morbidity in children with sickle cell anemia; however, the mechanism of injury is poorly understood. Increased cerebral blood flow and low hemoglobin levels in children with sickle cell anemia are associated with increased stroke risk, suggesting that anemia-induced tissue hypoxia may be an important factor contributing to subsequent morbidity. To better understand the pathophysiology of brain injury, brain physiology and morphology were characterized in a transgenic mouse model, the Townes sickle cell model. Relative to age-matched controls, sickle cell anemia mice demonstrated: (1) decreased brain tissue pO 2 and increased expression of hypoxia signaling protein in the perivascular regions of the cerebral cortex; (2) elevated basal cerebral blood flow , consistent with adaptation to anemia-induced tissue hypoxia; (3) significant reduction in cerebrovascular blood flow reactivity to a hypercapnic challenge; (4) increased diameter of the carotid artery; and (5) significant volume changes in white and gray matter regions in the brain, as assessed by ex vivo magnetic resonance imaging. Collectively, these findings support the hypothesis that brain tissue hypoxia contributes to adaptive physiological and anatomic changes in Townes sickle cell mice. These findings may help define the pathophysiology for stroke in children with sickle cell anemia.

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Surgical Revascularization Reverses Cerebral Cortical Thinning in Patients With Severe Cerebrovascular Steno-Occlusive Disease

Cited by 65 publications

References 42 publications

Brain Reorganization after Endovascular Treatment in a Patient with a Large Arteriovenous Malformation: The Role of Diagnostic and Functional Neuroimaging Techniques

Brain Reorganization after Endovascular Treatment in a Patient with a Large Arteriovenous Malformation: The Role of Diagnostic and Functional Neuroimaging Techniques

Cognitive Deterioration in Bilateral Asymptomatic Severe Carotid Stenosis

Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice

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