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Secondary thalamic degeneration after cerebral infarction in the middle cerebral artery distribution: evaluation with
T Ogawa1, Y Yoshida, T Okudera
1Department of Radiology and Nuclear Medicine, Research Institute of Brain and Blood Vessels-Akita, Senshu-kubota-machi, Japan.
Purpose:
To evaluate secondary degeneration of the ipsilateral thalamus after cerebral infarction in the middle cerebral artery (MCA) distribution by using magnetic resonance (MR) imaging.
Materials And Methods:
Thirty patients (17 men, 13 women; aged 30-85 years) with embolic cerebral infarction in the MCA distribution underwent serial MR imaging 2 hours to 12 months after a stroke. In 23 of the 30 patients, the authors evaluated cerebral blood flow with single photon emission computed tomography (SPECT).
Results:
T2-weighted spin-echo images disclosed a hyperintense area in the ipsilateral thalamus in 14 patients (47%) 1-12 months after stroke. The hyperintense area was confined to the dorsomedial or anterior and dorsomedial nuclei of the thalamus in nine of the 14 patients; it extended from the dorsomedial or anterior and dorsomedial nuclei to the ventral lateral nucleus or pulvinar in the remaining five patients. Hypoperfusion of the ipsilateral thalamus was observed in 21 of the 23 patients who underwent SPECT. Twelve of the 21 patients also showed a hyperintense area in the ipsilateral thalamus on the MR images.
Conclusion:
MR imaging is useful in evaluating secondary thalamic degeneration after cerebral infarction. In clinical practice, this secondary degeneration should not be mistaken for other lesions such as further cerebral infarction.
Insights
Magnetic resonance (MR) imaging can detect secondary thalamic degeneration after middle cerebral artery (MCA) infarction. This condition, characterized by thalamic hyperintensities and hypoperfusion, should be differentiated from new infarcts.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Cerebral infarction, particularly in the middle cerebral artery (MCA) distribution, can lead to secondary neurological deficits.
- Thalamic degeneration is a potential consequence of cerebral infarction, impacting neurological function.
- Magnetic resonance (MR) imaging offers detailed visualization of brain structures and potential pathological changes.
Purpose of the Study:
- To evaluate secondary degeneration of the ipsilateral thalamus following cerebral infarction in the MCA territory.
- To assess the utility of MR imaging in identifying thalamic changes post-stroke.
- To correlate imaging findings with cerebral blood flow in affected patients.
Main Methods:
- Serial MR imaging was performed on 30 patients with MCA infarction over 12 months.
- Single photon emission computed tomography (SPECT) was used to evaluate cerebral blood flow in 23 patients.
- T2-weighted spin-echo MR images were analyzed for thalamic hyperintensities.
Main Results:
- Thalamic hyperintensities on MR imaging were observed in 47% of patients between 1 and 12 months post-stroke.
- SPECT revealed ipsilateral thalamic hypoperfusion in 21 of 23 patients.
- A correlation was found between thalamic hypoperfusion and MR-detected hyperintensities in 12 patients.
Conclusions:
- MR imaging is a valuable tool for detecting secondary thalamic degeneration after cerebral infarction.
- Recognizing these secondary changes is crucial to avoid misdiagnosis, such as mistaking them for new infarcts.
- The findings highlight the importance of considering thalamic involvement in the post-stroke recovery process.