Mechanisms of Bihemispheric Brain Infarctions in the Anterior Circulation on Diffusion-Weighted Images
Kozue Saitoa,
Hiroshi Moriwakia,
Hiroshi Oea,
Kotaro Miyashitaa,
Kazuyuki Nagatsukaa,
Satoshi Uenob and
Hiroaki Naritomia
a Department of Medicine, Cerebrovascular Division, Nara Medical University, Osaka, Japan
b Department of Neurology, Nara Medical University, Osaka, Japan
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FIG 1. Classification of infarction.
A, Right-sided infarction was defined as territorial; left sided, subcortical. Total volume of the infarcts was smaller on the left than right, which was defined as the predominantly affected hemisphere.
B, DWI shows small disseminated lesions. The predominantly affected hemisphere is the left side, and infarcts on the contralateral side are localized in the ACA area.
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FIG 2. Angiographic and DWI findings in four patients in group CA. A/M = watershed area between the ACA and MCA, Lt. = left, Rt. = right, gray circle = carotid stenotic lesion or complicated lesion in the arch; black circle = culprit lesion; asterisk = cross-flow, intracranial cross-flow through the AcoA from the predominantly affected side to the contralateral side; double asterisk = right MCA area, which was supplied by the left ICA through the AcoA because the right ICA was completely occluded at the origin; and triple asterisk = aortic lesion, which remains unknown because of the lack of transesophageal echocardiography.
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