Bony Stroke: Ischemic Stroke Caused by Mechanical Stress on Brain Supplying Arteries From Anatomical Bone or
Johanna Haertl1, Martin Renz2, Silke Wunderlich1
1Department of Neurology (J.H., S.W., B. Hemmer, B.D.I.), Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Germany.
Insights
Bony stroke, a rare cause of ischemic stroke due to bone or cartilage anomalies affecting brain arteries, requires interdisciplinary evaluation and treatment. This approach successfully prevented further strokes in studied patients.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Bone or cartilage anomalies affecting brain arteries can cause ischemic stroke, a condition termed 'bony stroke'.
- This rare entity lacks standardized diagnostic and therapeutic protocols.
- Understanding bony stroke is crucial for managing recurrent ischemic events of unknown origin.
Purpose of the Study:
- To retrospectively analyze the diagnostic and therapeutic workup for patients with bony stroke.
- To evaluate the effectiveness of interdisciplinary management in preventing recurrent ischemic events.
Main Methods:
- Retrospective review of 6 patients diagnosed with bony stroke between January 2017 and March 2022.
- Diagnosis involved a combination of imaging modalities including ultrasound, CT, and MRI, with dynamic imaging used in some cases.
- Treatment strategies were multidisciplinary, including conservative management, endovascular procedures, and surgical interventions.
Main Results:
- Six cases of bony stroke were identified among 4200 acute ischemic stroke patients.
- All patients presented with recurrent ischemic strokes prior to diagnosis.
- Dynamic imaging confirmed vessel affection with head movements in 50% of cases.
- Various treatments were employed, including conservative, endovascular, and surgical options.
- No patient experienced further ischemic events during a mean follow-up of 11.7 months.
Conclusions:
- Bony stroke should be considered in patients with recurrent ischemic stroke of unknown etiology in a specific vascular territory.
- Interdisciplinary evaluation and treatment are effective in preventing stroke recurrence.
Background:
Bone or cartilage anomalies with affection of brain supplying arteries are a potential structural cause for ischemic stroke. In the following, we termed this entity bony stroke. Due to rarity of their description, there is no standardized workup and therapy for bony strokes.
Methods:
Retrospectively, we extracted diagnostic and therapeutic workup of all patients considered to have had a bony stroke between January 2017 to March 2022 at our comprehensive care center.
Results:
In total, 6 patients classified as a bony stroke were identified among 4200 acute patients with ischemic stroke treated during the study period. Each patient had recurrent ischemic strokes in the dependent vascular territory before diagnosis. Diagnosis was achieved by a combination of imaging devices, including sonography, computed tomography, and magnetic resonance imaging. In addition to conventional static imaging, the application of dynamic imaging modalities with the patients' head in rotation or reclination confirmed a vessel affection following head movements in 3 patients (50%). Treatment options were interdisciplinary assessed and included the following: conservative treatment (n=1), endovascular stenting (n=2) or occlusion (n=2), surgical removal of bone/ cartilage (n=2), and surgical bypass treatment (n=1). In follow-up (mean 11.7 months), no patient experienced further ischemia.
Conclusions:
As a differential diagnosis, bony strokes may be considered in patients with recurrent ischemic stroke of unknown cause in one dependent vascular territory. Interdisciplinary evaluation and treatment may eliminate risk of stroke recurrence.
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