Medullary streaks in a patient with atherosclerotic internal carotid artery occlusion: case report
Chiaki Mikami1, Takashi Inoue, Kuniaki Ogasawara
1Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
Background:
Magnetic resonance imaging (MRI) of a patient with atherosclerotic internal carotid artery (ICA) occlusion demonstrated medullary streaks in the deep white matter, which were previously observed only in moyamoya disease and may indicate decreased cerebral blood flow. Cerebral perfusion and metabolism were evaluated using positron emission tomography (PET).
Case Description:
A 46-year-old man presented with right hemiparesis and motor aphasia. Cerebral angiography showed left cervical ICA occlusion. MRI showed medullary streaks in the deep white matter of the left middle cerebral artery (MCA) territory. PET imaging of this region revealed decreased cerebral blood flow and increased oxygen extraction fraction and cerebral blood volume. MRI after superficial temporal artery-MCA anastomosis revealed decreased intensity of the medullary streaks.
Conclusions:
Medullary streaks in patients with atherosclerotic ICA occlusion may indicate reduced perfusion pressure and increased risk of recurrent stroke.
Insights
Medullary streaks seen on MRI in atherosclerotic internal carotid artery occlusion may signal reduced cerebral blood flow. This finding suggests an increased risk of recurrent stroke in affected patients.
Area of Science:
- Neurology
- Neuroradiology
- Cerebrovascular Disease
Background:
- Atherosclerotic internal carotid artery (ICA) occlusion can lead to reduced cerebral blood flow.
- Medullary streaks in deep white matter are typically associated with moyamoya disease.
Observation:
- MRI revealed medullary streaks in a patient with atherosclerotic ICA occlusion.
- Positron emission tomography (PET) demonstrated decreased cerebral blood flow and altered oxygen extraction fraction in the affected region.
- Post-surgical MRI showed reduced intensity of medullary streaks.
Findings:
- Medullary streaks can be an indicator of reduced cerebral perfusion pressure.
- The presence of medullary streaks correlates with decreased cerebral blood flow in atherosclerotic ICA occlusion.
Implications:
- Medullary streaks may signify an elevated risk of recurrent stroke.
- This imaging finding could aid in identifying patients needing closer monitoring or intervention for cerebrovascular disease.
