Case Report: Serial MR Vessel Wall Imaging Visualizes the Response of Intracranial Plaques and Assists in
Jiayu Xiao1,2, Matthew M Padrick3, Shlee S Song3
1Departments of Radiology, Keck School of Medicine of USC, Los Angeles, CA, United States.
Insights
Intracranial atherosclerotic disease (ICAD) can lead to stroke. This case report shows a plaque worsening despite medication, highlighting the need for better monitoring in ICAD patients.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Intracranial atherosclerotic disease (ICAD) is a significant cause of ischemic stroke.
- Symptomatic ICAD patients face a high risk of recurrent stroke, even with standard medical management.
Observation:
- Serial MRI was used to monitor plaque progression in a 47-year-old male with occipital lobe infarction.
- The study tracked plaque morphology and signal changes over 12 months post-stroke.
Findings:
- One intracranial atherosclerotic plaque showed significant worsening at the 3-month follow-up.
- This progression occurred despite a reduction in the patient's low-density lipoprotein levels.
Implications:
- Early identification of non-responsive ICAD plaques is crucial for preventing recurrent cardiovascular events.
- This case underscores the importance of advanced imaging in assessing treatment efficacy for ICAD.
Abstract:
Intracranial atherosclerotic disease (ICAD) is a dynamic process that leads to ischemic stroke. Symptomatic ICAD patients still suffer a high recurrent rate even under standard treatment. In this case report, to better understand the response of intracranial atherosclerotic plaques to medication, serial MR imaging was added to standard clinical workup in a 47-year-old male patient with acute occipital lobe infarction at baseline, 3-month, 6-month, and 12-month post index stroke to directly visualize the morphology and signal change of plaques. We noticed that one of the plaques showed dramatic worsening at 3-month imaging follow-up despite a decrease in low-density lipoprotein level. Early identification of patients who do not respond well to medication is critical to prevent the recurrence of cardiovascular events in ICAD patients.
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