Si Eun Kim1, Byung In Lee1, Sung Eun Kim1, Kyong Jin Shin1, JinSe Park1, Kang Min Park1, Hyung Chan Kim1, Joonwon Lee1, Hye Jin Baek1, Sung-Cheol Jin1, Sam Yeol Ha2. 1. From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.). 2. From the Departments of Neurology (Si Eun Kim, B.I.L., Sung Eun Kim, K.J.S., J.P., K.M.P., H.C.K., J.L., S.Y.H.) and Neurosurgery (S.-c.J.), Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea; and Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea (H.J.B.). H00251@paik.ac.kr.
Abstract
BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery vascular hyperintensities (FVHs) are seen in some cases with cerebral hemodynamic impairment and collateral flow. Because the worst outcomes of patients with borderzone infarcts were mainly correlated with impaired hemodynamics, the presence of FVH might provide another clue for predicting the prognosis of patients with borderzone infarcts. METHODS: We reviewed 1377 consecutive patients with ischemic stroke. Cortical borderzone (CBZ) and internal borderzone infarcts were selected based on diffusion-weighted imaging. FVHs were defined as tubular- or serpentine-shaped hyperintensities in the subarachnoid space. We investigated the clinical significance of FVHs in borderzone-infarcted patients. RESULTS: Among 87 patients with borderzone infarcts, the presence of FVH was observed in 30 (34.5%). We identified 62 patients with CBZ infarcts and 25 patients with internal borderzone infarcts. In the cases with CBZ infarcts, the initial National Institutes of Health Stroke Scale scores and the portions of nonfavorable outcome at 3 months in the FVH(+) group were significantly higher than in the FVH(-) group (P<0.05 and P<0.001, respectively). Unlike the cases with CBZ infarcts, there were no significant differences of these clinical features between the FVH(+) group and the FVH(-) group in the patients with internal borderzone infarcts. CONCLUSIONS: The findings of FVH are associated with relatively severe clinical presentation and nonfavorable prognosis in patients with CBZ infarcts, but not in patients with internal borderzone infarcts. The presence of FVH may help to identify CBZ-infarcted patients who require close observation and hemodynamic control.
BACKGROUND AND PURPOSE: Fluid-attenuated inversion recovery vascular hyperintensities (FVHs) are seen in some cases with cerebral hemodynamic impairment and collateral flow. Because the worst outcomes of patients with borderzone infarcts were mainly correlated with impaired hemodynamics, the presence of FVH might provide another clue for predicting the prognosis of patients with borderzone infarcts. METHODS: We reviewed 1377 consecutive patients with ischemic stroke. Cortical borderzone (CBZ) and internal borderzone infarcts were selected based on diffusion-weighted imaging. FVHs were defined as tubular- or serpentine-shaped hyperintensities in the subarachnoid space. We investigated the clinical significance of FVHs in borderzone-infarctedpatients. RESULTS: Among 87 patients with borderzone infarcts, the presence of FVH was observed in 30 (34.5%). We identified 62 patients with CBZinfarcts and 25 patients with internal borderzone infarcts. In the cases with CBZinfarcts, the initial National Institutes of Health Stroke Scale scores and the portions of nonfavorable outcome at 3 months in the FVH(+) group were significantly higher than in the FVH(-) group (P<0.05 and P<0.001, respectively). Unlike the cases with CBZinfarcts, there were no significant differences of these clinical features between the FVH(+) group and the FVH(-) group in the patients with internal borderzone infarcts. CONCLUSIONS: The findings of FVH are associated with relatively severe clinical presentation and nonfavorable prognosis in patients with CBZinfarcts, but not in patients with internal borderzone infarcts. The presence of FVH may help to identify CBZ-infarctedpatients who require close observation and hemodynamic control.
Authors: Lei Song; Cui Lyu; Guiquan Shen; Tingting Guo; Jiangtao Wang; Wanbi Wang; Xiaoming Qiu; Alexander Lerner; Max Wintermark; Bo Gao Journal: Front Neurol Date: 2019-09-26 Impact factor: 4.003