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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
Insights
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.
Purpose:
To investigate the relationship between the patterns of cerebral infarction that have been associated with hemodynamic impairment and the presence of severe chronic hemodynamic compromise (increased oxygen extraction fraction) in a large prospectively enrolled group of patients with carotid artery occlusion.
Materials And Methods:
At enrollment in a prospective study of cerebral hemodynamics, 110 patients with carotid occlusion underwent (a) positron emission tomography for the measurement of cerebral oxygen extraction fraction and (b) computed tomographic (CT) or magnetic resonance (MR) examinations of the brain. Infarcts were categorized retrospectively by vascular territory, location, and pattern. The association of these findings with hemodynamic impairment (increased oxygen extraction fraction) was investigated.
Results:
No border zone-region infarctions were found in 35 asymptomatic patients. In 75 symptomatic patients, cortical border zone-region infarction was found in seven of 36 patients with increased oxygen extraction fraction, and in two of 39 with normal oxygen extraction fraction (P =.08, difference not significant). The pattern of multiple white matter lesions arranged parallel to the lateral ventricle was observed only in symptomatic patients with increased oxygen extraction fraction (eight of 36 patients; P =.002; sensitivity, 22%; specificity, 100%). This finding was more frequent with MR imaging (seven of 14 patients) than with CT (one of 22 patients).
Conclusion:
Multiple white matter infarctions, arranged parallel to the lateral ventricle, are associated with severe hemodynamic impairment. This pattern of infarction is likely due to a hemodynamic mechanism.