Emi Hitomi1, Alexis N Simpkins1, Marie Luby1, Lawrence L Latour1, R John Leigh1, Richard Leigh2. 1. From the National Institute of Neurological Disorders and Stroke (E.H., A.N.S., M.L., L.L.L., R.L.), NIH, Bethesda, MD; and Department of Neurology (R.J.L.), Case Western Reserve University, Cleveland, OH. 2. From the National Institute of Neurological Disorders and Stroke (E.H., A.N.S., M.L., L.L.L., R.L.), NIH, Bethesda, MD; and Department of Neurology (R.J.L.), Case Western Reserve University, Cleveland, OH. richard.leigh@nih.gov.
Abstract
OBJECTIVE: Prompted by the unexpected finding of gadolinium leakage into ocular structures (GLOS) in acute stroke patients, we studied the frequency and nature of this finding in 167 patients. METHODS: Patients were selected who had an MRI with gadolinium at baseline and another MRI with fluid-attenuated inversion recovery (FLAIR) imaging at 2 and/or 24 hours later. GLOS was detected as lack of vitreous and/or aqueous fluid suppression on postcontrast FLAIR images. RESULTS: GLOS, evident on postcontrast FLAIR MRI, occurred in 127/167 (76%) patients: 86/109 (79%) patients treated with tissue plasminogen activator and 41/58 (71%) who were untreated. At 2 hours after administration of the contrast, GLOS was more common in the aqueous chamber alone, occurring in 67% of patients, compared to the vitreous chamber alone, seen in 6% of patients; it occurred in both chambers in 27% of patients. At 24 hours, GLOS was present in 121/162 (75%) patients, always involving the vitreous chamber, but also affecting the aqueous chamber in 6% of cases. Vitreous GLOS at 24 hours was associated with increasing age (p = 0.002) and a higher burden of cerebral white matter hyperintensities (p = 0.017). Patients with rapid diffuse GLOS, defined as GLOS involving both chambers at 2 hours, had larger infarcts (p = 0.022) and a higher degree of blood-brain barrier permeability (p = 0.025). CONCLUSIONS: We found GLOS to be common in patients with acute stroke; delayed GLOS was a marker for chronic vascular disease. The mechanism for acute GLOS remains uncertain but may be a remote effect of acute cerebral injury on the blood-ocular barrier.
OBJECTIVE: Prompted by the unexpected finding of gadolinium leakage into ocular structures (GLOS) in acute strokepatients, we studied the frequency and nature of this finding in 167 patients. METHODS:Patients were selected who had an MRI with gadolinium at baseline and another MRI with fluid-attenuated inversion recovery (FLAIR) imaging at 2 and/or 24 hours later. GLOS was detected as lack of vitreous and/or aqueous fluid suppression on postcontrast FLAIR images. RESULTS:GLOS, evident on postcontrast FLAIR MRI, occurred in 127/167 (76%) patients: 86/109 (79%) patients treated with tissue plasminogen activator and 41/58 (71%) who were untreated. At 2 hours after administration of the contrast, GLOS was more common in the aqueous chamber alone, occurring in 67% of patients, compared to the vitreous chamber alone, seen in 6% of patients; it occurred in both chambers in 27% of patients. At 24 hours, GLOS was present in 121/162 (75%) patients, always involving the vitreous chamber, but also affecting the aqueous chamber in 6% of cases. Vitreous GLOS at 24 hours was associated with increasing age (p = 0.002) and a higher burden of cerebral white matter hyperintensities (p = 0.017). Patients with rapid diffuse GLOS, defined as GLOS involving both chambers at 2 hours, had larger infarcts (p = 0.022) and a higher degree of blood-brain barrier permeability (p = 0.025). CONCLUSIONS: We found GLOS to be common in patients with acute stroke; delayed GLOS was a marker for chronic vascular disease. The mechanism for acute GLOS remains uncertain but may be a remote effect of acute cerebral injury on the blood-ocular barrier.
Authors: Tien Yin Wong; Ronald Klein; A Richey Sharrett; David J Couper; Barbara E K Klein; Duan-Ping Liao; Larry D Hubbard; Thomas H Mosley Journal: JAMA Date: 2002-07-03 Impact factor: 56.272
Authors: W Hacke; M Kaste; C Fieschi; R von Kummer; A Davalos; D Meier; V Larrue; E Bluhmki; S Davis; G Donnan; D Schneider; E Diez-Tejedor; P Trouillas Journal: Lancet Date: 1998-10-17 Impact factor: 79.321
Authors: Wenyu Deng; Crystal Liu; Carlos Parra; Jeffrey R Sims; Muneeb A Faiq; Anoop Sainulabdeen; Hana Song; Kevin C Chan Journal: Quant Imaging Med Surg Date: 2020-01
Authors: Katerina Deike-Hofmann; Paula von Lampe; Heinz-Peter Schlemmer; Nikolaos Bechrakis; Christoph Kleinschnitz; Michael Forsting; Alexander Radbruch Journal: Eur Radiol Date: 2020-03-16 Impact factor: 5.315
Authors: Jeffrey R Sims; Anna M Chen; Zhe Sun; Wenyu Deng; Nicole A Colwell; Max K Colbert; Jingyuan Zhu; Anoop Sainulabdeen; Muneeb A Faiq; Ji Won Bang; Kevin C Chan Journal: J Magn Reson Imaging Date: 2020-10-02 Impact factor: 4.813
Authors: Abdul Kareem Parchur; Gayatri Sharma; Jaidip M Jagtap; Venkateswara Rao Gogineni; Peter S LaViolette; Michael J Flister; Sarah Beth White; Amit Joshi Journal: ACS Nano Date: 2018-07-06 Impact factor: 18.027