American Journal of Neuroradiology, Vol 19, Issue 6 1067-1074, Copyright © 1998 by American Society of Neuroradiology
ARTICLES |
Failure to identify cerebral infarct mechanisms from topography of vascular territory lesions
M Hennerici, M Daffertshofer and L Jakobs
Department of Neurology, University of Heidelberg, Klinikum Mannheim, Germany.
PURPOSE: Our purpose was to determine whether topographic patterns of ischemic damage seen on brain imaging studies are useful for evaluating different mechanisms of infarction and for distinguishing embolic from hemodynamic disorders. METHODS: Early CT scans were reviewed to identify brain infarctions in the middle cerebral artery territory in 800 patients with either significant obstructive lesions of the internal carotid artery (70% stenosis, n = 17; occlusion, n = 85) or nonvalvular atrial fibrillation (n = 186) as the only identified source of stroke. Ninety-nine CT studies were considered suitable for entry into the final analysis. The scans were digitized and superimposed on postmortem brain sections by matching algorithms to display the variability of the cerebrovascular territories. RESULTS: Cortical borderzone-type infarctions were rare and evenly distributed among patients with cardiac sources of embolism (3.2%) and severe carotid obstructions (3.6%). In contrast, subcortical borderzone infarcts occurred significantly more often in patients with carotid obstructive disease (36% versus 16%). However, on computerized segmentation analysis, the topography of infarction was the same in both groups. CONCLUSION: The current concept that stroke mechanisms can be inferred from interpretation of stroke patterns on brain scans is heavily confounded by the variability in intracranial arterial territory distributions. Since individual arterial territories cannot be identified in vivo, interpretation of stroke topography is invalidated. In particular, the cortical wedge-type of borderzone infarction, said to result from hemodynamic compromise in low-flow perfusion territories, is an ambiguous observation and may be seen in patients with cerebral embolism and hemodynamic compromise due to severe carotid disease.
This article has been cited by other articles:
 |
|
 |
|
  A. P. Kansagra and E. C. Wong Quantitative Assessment of Mixed Cerebral Vascular Territory Supply With Vessel Encoded Arterial Spin Labeling MRI Stroke, November 1, 2008; 39(11): 2980 - 2985. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Yong, O. Y. Bang, P. H. Lee, and W. Y. Li Internal and Cortical Border-Zone Infarction: Clinical and Diffusion-Weighted Imaging Features Stroke, March 1, 2006; 37(3): 841 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.H. Benninger, D. Georgiadis, C. Kremer, A. Studer, K. Nedeltchev, and R.W. Baumgartner Mechanism of Ischemic Infarct in Spontaneous Carotid Dissection Stroke, February 1, 2004; 35(2): 482 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Provenzale, R. Jahan, T. P. Naidich, and A. J. Fox Assessment of the Patient with Hyperacute Stroke: Imaging and Therapy Radiology, November 1, 2003; 229(2): 347 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H. C. Bisschops, C. J. M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Prevalence and Volume of Internal Border Zone Lesions in Patients With Impaired Cerebral Carbon Dioxide Vasomotor Reactivity: A Follow-up Study Arch Neurol, September 1, 2003; 60(9): 1233 - 1236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. H.C. Bisschops, C. J.M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion Neurology, May 13, 2003; 60(9): 1435 - 1441. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Arakawa, K. Minematsu, T. Hirano, Y. Tanaka, Y. Hasegawa, K. Hayashida, and T. Yamaguchi Topographic Distribution of Misery Perfusion in Relation to Internal and Superficial Borderzones AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 427 - 435. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. C. Bisschops, C. J. M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Association Between Impaired Carbon Dioxide Reactivity and Ischemic Lesions in Arterial Border Zone Territories in Patients With Unilateral Internal Carotid Artery Occlusion Arch Neurol, February 1, 2003; 60(2): 229 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Gass, K. Szabo, S. Behrens, C. Rossmanith, and M. Hennerici A diffusion-weighted MRI study of acute ischemic distal arm paresis Neurology, November 13, 2001; 57(9): 1589 - 1594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Derdeyn, A. Khosla, T. O. Videen, S. M. Fritsch, D. L. Carpenter, R. L. Grubb Jr, and W. J. Powers Severe Hemodynamic Impairment and Border Zone-Region Infarction Radiology, July 1, 2001; 220(1): 195 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Kim Predominant involvement of a particular group of fingers due to small, cortical infarction Neurology, June 26, 2001; 56(12): 1677 - 1682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Nasel, A. Azizi, A. Wilfort, R. Mallek, and E. Schindler Measurement of Time-to-peak Parameter by Use of a New Standardization Method in Patients with Stenotic or Occlusive Disease of the Carotid Artery AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1056 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Szabo, R. Kern, A. Gass, J. Hirsch, and M. Hennerici Acute Stroke Patterns in Patients With Internal Carotid Artery Disease : A Diffusion-Weighted Magnetic Resonance Imaging Study Stroke, June 1, 2001; 32(6): 1323 - 1329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. M. Klijn, L. J. Kappelle, J. van der Grond, A. Algra, C. A. F. Tulleken, and J. van Gijn Magnetic Resonance Techniques for the Identification of Patients With Symptomatic Carotid Artery Occlusion at High Risk of Cerebral Ischemic Events Stroke, December 1, 2000; 31(12): 3001 - 3007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Del Sette, M. Eliasziw, J. Y. Streifler, V. C. Hachinski, A. J. Fox, and H. J. M. Barnett Internal Borderzone Infarction : A Marker for Severe Stenosis in Patients With Symptomatic Internal Carotid Artery Disease Stroke, March 1, 2000; 31(3): 631 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Muller, W. Reiche, P. Langenscheidt, J. Ha{beta}feld, and T. Hagen Ischemia after Carotid Endarterectomy: Comparison between Transcranial Doppler Sonography and Diffusion-Weighted MR Imaging AJNR Am. J. Neuroradiol., January 1, 2000; 21(1): 47 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Darby, P. A. Barber, R. P. Gerraty, P. M. Desmond, Q. Yang, M. Parsons, T. Li, B. M. Tress, and S. M. Davis Pathophysiological Topography of Acute Ischemia by Combined Diffusion-Weighted and Perfusion MRI Stroke, October 1, 1999; 30(10): 2043 - 2052. [Abstract] [Full Text] [PDF]
|
|