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Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection
Mirjam R Heldner1, Mila Nedelcheva1, Xin Yan1
1Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
Insights
Intramural hematomas in spontaneous internal carotid artery dissection often increase initially but resolve within six months. Early follow-up imaging is recommended, especially if new symptoms arise.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Investigated temporal and spatial evolution of intramural hematomas in acute spontaneous internal carotid artery dissection.
- Utilized repeated magnetic resonance imaging (MRI) over a six-month period.
Purpose of the Study:
- Assess dynamic changes of intramural hematoma in spontaneous internal carotid artery dissection.
- Utilized multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography (MRA).
Main Methods:
- Serial multiparametric MRI performed on 10 patients.
- Imaging included admission, days 1, 3, 7-14, and months 1.5, 3, and 6.
- Calculated hematoma volume and stenosis degree using T1w, PD/T2w fat-suppressed sequences, and MRA.
Main Results:
- Mean interval to first MRI was two days.
- Nine patients showed transient hematoma volume increase, primarily up to day 10.
- 80% of patients had no detectable hematoma at three months, with complete resolution by six months.
Conclusions:
- Spontaneous internal carotid artery dissection shows early hematoma volume increase and potential stenosis progression.
- Overall prognosis is good, with complete hematoma resorption in all patients.
- Early follow-up imaging is advisable, particularly with new clinical symptoms.
Background:
We prospectively investigated temporal and spatial evolution of intramural hematomas in patients with acute spontaneous internal carotid artery dissection using repeated magnetic resonance imaging over six-months.
Aim:
The aim of the present study was to assess dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection at multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography.
Methods:
We performed serial multiparametric magnetic resonance imaging in 10 patients with spontaneous internal carotid artery dissection on admission, at days 1, 3, 7-14 and at months 1·5, 3, and 6. We calculated the volume and extension of the hyperintense intramural hematoma using T1w and PD/T2w fat suppressed sequences and assessed the degree of stenosis due to the hematoma using magnetic resonance angiography.
Results:
Mean interval from symptom onset to first magnetic resonance imaging was two-days (SD 2·7). Two patients presented with ischemic stroke, three with transient ischemic attacks, and five with pain and local symptoms only. Nine patients had a transient increase of the intramural hematoma volume, mainly up to day 10 after symptom onset. Fifty percent had a transient increase in the degree of the internal carotid artery stenosis on MRA, one resulting in a temporary occlusion. Lesions older than one-week were predominantly characterized by a shift from iso- to hyperintese signal on T2w images. At three-month follow-up, intramural hematoma was no longer detectable in 80% of patients and had completely resolved in all patients after six-months.
Conclusions:
Spatial and temporal dynamics of intramural hematomas after spontaneous internal carotid artery dissection showed an early volume increase with concomitant progression of the internal carotid artery stenosis in 5 of 10 patients. Although spontaneous internal carotid artery dissection overall carries a good prognosis with spontaneous hematoma resorption in all our patients, early follow-up imaging may be considered, especially in case of new clinical symptoms.
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