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Transient Middle Cerebral Artery Occlusion Model of Neonatal Stroke in P10 Rats
Published on: April 21, 2017
Pattern of cortex and white matter involvement in severe middle cerebral artery ischemia
Maria Cornelia Stoeckel1, Hans-Jörg Wittsack, Stephanie Meisel
1Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany.
Background And Purpose:
In middle cerebral artery (MCA) stroke, ischemia usually is unevenly distributed within the MCA territory. We sought to investigate which brain structures are critical for the acute neurological deficit in severe MCA stroke.
Methods:
We used magnetic resonance (MR) imaging and statistical parametric mapping in 64 consecutive stroke patients (64 +/-13 years) to study the pattern of the initial perfusion abnormality.
Results:
Patients with lesion progression had more severe time-to-peak (TTP) abnormalities (P < .0001) in the inferior frontal gyrus, superior temporal gyrus, insula, and underlying hemispheric white matter than those with lesion regression. Also, patients with lesion progression had more severe T2 abnormalities on day 8 than those with lesion regression. In contrast, the changes of water diffusion were similar among the two groups resulting in a perfusion-diffusion mismatch in lesion progression. TTP-lesions were related to the neurological deficit score (r(s)=-0.563, P < .0001), T2-lesions (r= 0.686, P < .0001), and cerebral artery abnormalities assessed on MR-angiography (r(s)= 0.399, P < .01).
Conclusions:
In major MCA, stroke ischemia was most severe in the central portion of the MCA territory. It is suggested that involvement of hemispheric white matter accentuated the neurological deficit probably by affecting cortico-cortical and cortico-subcortical fibers.
Insights
In severe middle cerebral artery (MCA) stroke, the most critical areas for acute neurological deficits are the inferior frontal gyrus, superior temporal gyrus, and insula. Hemispheric white matter involvement significantly worsens deficits by disrupting brain connections.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Middle cerebral artery (MCA) stroke often presents with uneven ischemia distribution.
- Understanding critical brain structures is key to managing acute neurological deficits.
Purpose of the Study:
- To identify brain structures most critical for acute neurological deficits in severe MCA stroke.
- To investigate the pattern of initial perfusion abnormalities using MR imaging.
Main Methods:
- Magnetic resonance (MR) imaging and statistical parametric mapping were used.
- 64 consecutive stroke patients were analyzed.
- Perfusion abnormalities were studied in relation to lesion progression and neurological deficits.
Main Results:
- Lesion progression correlated with severe time-to-peak (TTP) abnormalities in the inferior frontal gyrus, superior temporal gyrus, insula, and white matter.
- Patients with lesion progression showed more severe T2 abnormalities.
- A perfusion-diffusion mismatch was observed in cases of lesion progression.
Conclusions:
- Severe ischemia in MCA stroke is concentrated in the central MCA territory.
- Involvement of hemispheric white matter exacerbates neurological deficits by impacting crucial neural fibers.
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