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Severe hemodynamic impairment and border zone--region infarction
C P Derdeyn1, A Khosla, T O Videen
1Neuroradiology Section, Division of Radiological Sciences, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. derdeync@mir.wust.edu
Radiology
|June 27, 2001
Summary
Multiple white matter infarctions parallel to the lateral ventricle are linked to severe hemodynamic compromise in carotid artery occlusion patients. This specific pattern suggests a hemodynamic cause for these brain injuries.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Carotid artery occlusion can lead to hemodynamic compromise, affecting cerebral blood flow.
- Understanding infarction patterns associated with hemodynamic impairment is crucial for patient management.
Purpose of the Study:
- To explore the connection between cerebral infarction patterns and severe chronic hemodynamic compromise (elevated oxygen extraction fraction).
- To investigate this relationship in a large cohort of patients with carotid artery occlusion.
Main Methods:
- 110 patients with carotid occlusion underwent positron emission tomography (PET) for oxygen extraction fraction (OEF) measurement.
- Brain CT or MRI scans were used to identify and categorize infarcts by territory, location, and pattern.
- Statistical analysis investigated the association between infarct patterns and hemodynamic impairment (elevated OEF).
Main Results:
- No border zone infarctions were observed in asymptomatic patients.
- Symptomatic patients with elevated OEF showed a higher incidence of cortical border zone infarctions (though not statistically significant).
- A distinct pattern of multiple white matter lesions parallel to the lateral ventricle was exclusively found in symptomatic patients with elevated OEF (22% sensitivity, 100% specificity), more frequently detected by MRI.
Conclusions:
- Multiple white matter infarctions arranged parallel to the lateral ventricle are significantly associated with severe hemodynamic impairment.
- This specific infarction pattern is likely a result of hemodynamic mechanisms in patients with carotid artery occlusion.