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Published on: July 21, 2013
Middle cerebral artery occlusion causing intracerebral hemorrhage: radiologic findings
1Department of Radiology, Saga Medical School; Nabeshima, Saga, Japan - uchino@med.saga-u.ac.jp.
Abstract:
Middle cerebral artery (MCA) occlusion usually leads to cerebral infarction but rarely causes cerebral hemorrhage without infarction. We retrospectively investigated the unique radiographic manifestations in cases of cerebral hemorrhage without infarction. Computed tomography (CT) and angiographic images obtained in four patients (aged 26 to 70 years) with MCA occlusion associated with intracerebral hemorrhage were reviewed. Two patients also underwent magnetic resonance imaging (MRI), and one of these underwent magnetic resonance angiography as well; these images were also examined. Cranial CT revealed periventricular hemorrhage with ventricular penetration in one patient and with putaminal penetration in two. Solitary ventricular hemorrhage was found in the fourth patient. Angiography showed ipsilateral occlusion at the M1 portion of the MCA, accompanied by moyamoya-like vessels. No aneurysm or arteriovenous malformation was detected. MRI showed absence of the flow void in the affected MCA and an abnormal flow void in dilated collateral vessels in the basal ganglia. MCA occlusion can cause periventricular or ventricular hemorrhage, which appears to result from bleeding from fragile dilated collateral vessels and, thus, to have an etiology similar to that of adult moyamoya disease. MRI shows promise as a tool for evaluating the occlusion site.
Insights
Middle cerebral artery (MCA) occlusion rarely causes cerebral hemorrhage without infarction. This study reveals unique imaging findings of hemorrhage from fragile collateral vessels, similar to moyamoya disease.
Area of Science:
- Neurology
- Radiology
- Vascular Neurology
Background:
- Middle cerebral artery (MCA) occlusion typically results in cerebral infarction.
- Cerebral hemorrhage without infarction due to MCA occlusion is a rare clinical presentation.
Purpose of the Study:
- To investigate the unique radiographic manifestations of cerebral hemorrhage without infarction in MCA occlusion.
- To elucidate the potential etiology and diagnostic imaging features of this condition.
Main Methods:
- Retrospective review of computed tomography (CT), angiography, and magnetic resonance imaging (MRI) in four patients with MCA occlusion and intracerebral hemorrhage.
- Detailed analysis of imaging findings, including hemorrhage location, MCA status, and collateral vessel appearance.
Main Results:
- CT revealed periventricular hemorrhage with ventricular or putaminal penetration in three patients and solitary ventricular hemorrhage in one.
- Angiography demonstrated M1 segment MCA occlusion with moyamoya-like collateral vessels, excluding aneurysms or arteriovenous malformations.
- MRI showed absent flow void in the occluded MCA and abnormal flow voids in dilated basal ganglia collateral vessels.
Conclusions:
- MCA occlusion can lead to periventricular or ventricular hemorrhage, likely from bleeding of fragile collateral vessels, sharing an etiology with adult moyamoya disease.
- MRI is a valuable tool for evaluating MCA occlusion and associated hemorrhage patterns.
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