scholarly journals Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients With Acute Large Hemispheric Infarction

2021 ◽  
Vol 12 ◽  
Author(s):  
Hai-Bin Xu ◽  
Yu-Fei Sun ◽  
Na Luo ◽  
Jia-Qi Wang ◽  
Guo-Can Chang ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Water Uptake ◽  
Cerebral Artery ◽  
Roc Curve ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
Predictive Ability ◽  
Middle Cerebral Artery Territory ◽  
Decompressive Craniotomy ◽  
Hemispheric Infarction

Background and purpose: Previous studies have demonstrated that Net Water Uptake (NWU) is associated with the development of malignant edema (ME). The current study aimed to investigate whether NWU calculated in standardized and blindly outlined regions of the middle cerebral artery can predict the development of ME.Methods: We retrospectively included 119 patients suffering from large hemispheric infarction within onset of 24 h. The region of the middle cerebral artery territory was blindly outlined in a standard manner to calculate NWU. Patients were divided into two groups according to the occurrence of ME, which is defined as space-occupying infarct requiring decompressive craniotomy or death due to cerebral hernia in 7 days from onset. The clinical characteristics were analyzed, and the receiver operating characteristic curve (ROC curve) was used to assess the predictive ability of NWU and other factors for ME.Results: Multivariable analysis showed that NWU was an independent predictor of ME (OR 1.168, 95% CI 1.041–1.310). According to the ROC curve, NWU≥8.127% identified ME with good predictive power (AUC 0.734, sensitivity 0.656, specificity 0.862).Conclusions: NWU calculated in standardized and blindly outlined regions of the middle cerebral artery territory is also a good predictor for the development of ME in patients with large hemispheric infarction.

scholarly journals The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

2021 ◽  
Author(s):  
Kilian Fröhlich ◽  
Gabriela Siedler ◽  
Svenja Stoll ◽  
Kosmas Macha ◽  
Thomas M. Kinfe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Middle Cerebral Artery Territory ◽  
Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

Susceptibility-diffusion mismatch in middle cerebral artery territory acute ischemic stroke: clinical and imaging implications

2016 ◽  
Vol 58 (7) ◽  
pp. 876-882 ◽  
Author(s):  
Seyedmehid Payabvash ◽  
Shayandokht Taleb ◽  
John C Benson ◽  
Benjamin Hoffman ◽  
Mark C Oswood ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Middle Cerebral Artery Territory

scholarly journals Comparison of Ischemic and Hemorrhagic Stroke in the Medical Ward of Dessie Referral Hospital, Northeast Ethiopia: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Hussen Abdu ◽  
Fentaw Tadese ◽  
Girma Seyoum
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Hemorrhagic Stroke ◽  
Medical Ward ◽  
Body Parts ◽  
Middle Cerebral Artery Territory ◽  
Common Site ◽  
Stroke Patients ◽  
Stroke Subtypes

Background. Distinguishing the category of stroke plays a vital role in planning patient care. Simple clinical findings help distinguish the type of stroke. However, there is a need for diagnostic imaging. In Ethiopia, stroke is the most common neurological condition in patients admitted to hospitals. Yet, there are limited data on comparisons of stroke subtypes. Thus, this study was designed to determine the prevalence of stroke and to compare ischemic and hemorrhagic strokes. Methods. A retrospective cross-sectional study design was employed. Medical records containing complete information and confirmed diagnosis using imaging techniques were included. The data were entered into SPSS version 24.0 for analysis. Results with a P value of <0.05 were considered statistically significant. Results. From a total of 312 stroke patients, 204 (65.4%) patients were admitted due to ischemic stroke. More females, 59 (18.9%), were admitted for hemorrhagic stroke than males. In both ischemic, 175 (56.1%) and hemorrhagic, 91 (29.2%) stroke cases, most of the patients were 45 years and above. Middle cerebral artery territory was the most common site of arterial territory infarctions in ischemic stroke, 158 (50.7%). Middle cerebral artery territory also was the most common site of hematoma in hemorrhagic stroke, 91 (29.2%). Infarctions in more than one lobe of the cerebrum (16.4%) and intracerebral hemorrhage in multiple areas of the cerebrum (7.4%) were observed in ischemic as well as hemorrhagic stroke cases. Most of the ischemic, 124 (39.8%), and hemorrhagic, 39 (12.5%), stroke patients presented loss of sensation and weakness of body parts. Hypertension was observed in 124 (39.8%) ischemic and 73 (23.4%) hemorrhagic stroke patients. The mortality rate of ischemic stroke, 47 (15.3%), was two times higher than hemorrhagic stroke, 20 (6.5%). Hypertension was the most common predictor of death in both ischemic and hemorrhagic stroke cases. Conclusions. Ischemic stroke is a common type of stroke in the medical ward of the study hospital. More females were affected by hemorrhagic stroke than males. Middle cerebral artery territory was the most affected area of the brain in both ischemic and hemorrhagic strokes. Most ischemic and hemorrhagic stroke patients were admitted due to loss of sensation and weakness of body parts. Hypertension was the most common risk factor of stroke as well as a predictor of stroke-related deaths. Identification of the stroke subtypes may be important in the management of stroke. Thus, health professionals, government officials, community leaders, and the population at large could be involved in creating awareness about antecedent risk factors and clinical presentations of stroke subtypes.

Abstract P509: Signal Intensity in the Middle Cerebral Artery as a Practical and Feasible Index of Hemodynamic Insufficiency Due to Carotid Artery Stenosis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka ◽  
Yuichi Miyazaki
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Roc Curve ◽  
Signal Intensity ◽  
Single Photon ◽  
Photon Emission ◽  
Oxygen Extraction Fraction ◽  
Arterial Oxygen ◽  
Upper Limit

Introduction: Intracranial hemorrhage occasionally occurs after carotid revascularization in presents with hemodynamic insufficiency. Positron emission tomography is unavailable in most facilities, and a feasible index is required to identify high-risk patients. Reduced signal intensity (SI) of the middle cerebral artery (MCA) on magnetic resonance angiography (MRA) is associated with postoperative hyperperfusion. Hypothesis: Reduced signal intensity (SI) of the MCA on MRA is associated with decreased regional cerebral blood flow (rCBF) on single-photon emission CT (SPECT) and increased blood-sampling whole-brain oxygen extraction fraction (wb-OEF). Methods: We included patients who: 1) were admitted from 2015 to 2019 for carotid artery stenting (CAS), 2) MRA, and SPECT before CAS, and 3) examined the wb-OEF immediately before CAS. We measured bilateral MCA SI on MRA and defined the MCA relative SI as (SI in the affected MCA)/ (SI in the contralateral MCA). We defined the rCBF% as rCBF in the affected MCA territory against the ipsilateral cerebellum. Before CAS, we sampled blood, measured the arterial oxygen and the venous oxygen content in the dominant-sided jugular vein, and calculated the wb-OEF. We evaluated the correlation between the MCA relative SI, the MCA slow flow, the rCBF%, and the wb-OEF. We estimated the upper limits of the MCA relative SI for the rCBF% < 80% or wb-OEF ≥ 0.40 using the area under the curve (AUC) values derived from the receiver operating characteristic (ROC) curves. Results: During the study period, 150 patients met our inclusion criteria. The MCA relative SI was positively correlated with rCBF% and negatively with the wb-OEF. The ROC curve for the rCBF% < 80% showed that the upper limit of the relative SI was 0.77 (the sensitivity of 53.9%, the specificity of 83.9%, AUC of 0.723). The ROC curve for the wb-OEF ≥ 0.40 showed that the upper limit of the relative SI was 0.95 (the sensitivity of 67.7%, the specificity of 55.2%, AUC of 0.625). Conclusion: Reduced MCA SI on MRA ≤ 0.77 is a practical and feasible index of hemodynamic insufficiency, indicating the decreased rCBF and increased wb-OEF.

scholarly journals Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Khalid Al-Dasuqi ◽  
Seyedmehdi Payabvash ◽  
Gerardo A. Torres-Flores ◽  
Sumita M. Strander ◽  
Cindy Khanh Nguyen ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Capsule ◽  
Large Vessel ◽  
Favorable Outcome ◽  
Middle Cerebral Artery Territory ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Deep White Matter ◽  
Border Zones

Background and Purpose: We aim to examine effects of collateral status and post-thrombectomy reperfusion on final infarct distribution and early functional outcome in patients with anterior circulation large vessel occlusion ischemic stroke. Methods: Patients with large vessel occlusion who underwent endovascular intervention were included in this study. All patients had baseline computed tomography angiography and follow-up magnetic resonance imaging. Collateral status was graded according to the criteria proposed by Miteff et al and reperfusion was assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) system. We applied a multivariate voxel-wise general linear model to correlate the distribution of final infarction with collateral status and degree of reperfusion. Early favorable outcome was defined as a discharge modified Rankin Scale score ≤2. Results: Of the 283 patients included, 129 (46%) had good, 97 (34%) had moderate, and 57 (20%) had poor collateral status. Successful reperfusion (mTICI 2b/3) was achieved in 206 (73%) patients. Poor collateral status was associated with infarction of middle cerebral artery border zones, whereas worse reperfusion (mTICI scores 0–2a) was associated with infarction of middle cerebral artery territory deep white matter tracts and the posterior limb of the internal capsule. In multivariate regression models, both mTICI ( P <0.001) and collateral status ( P <0.001) were among independent predictors of final infarct volumes. However, mTICI ( P <0.001), but not collateral status ( P =0.058), predicted favorable outcome at discharge. Conclusions: In this cohort of patients with large vessel occlusion stroke, both the collateral status and endovascular reperfusion were strongly associated with middle cerebral artery territory final infarct volumes. Our findings suggesting that baseline collateral status predominantly affected middle cerebral artery border zones infarction, whereas higher mTICI preserved deep white matter and internal capsule from infarction; may explain why reperfusion success—but not collateral status—was among the independent predictors of favorable outcome at discharge. Infarction of the lentiform nuclei was observed regardless of collateral status or reperfusion success.

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