Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection

Sebastian Koch, Murtaza Amir, Alejandro A. Rabinstein, Yolanda Reyes-Iglesias, Jose G Romano, Alejandro Forteza

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Abstract

Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Design: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Setting: Large community-based teaching hospital. Patients: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Main Outcome Measure: Infarct patterns were analyzed according to established templates of vascular territories. Results: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). Conclusions: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

Original languageEnglish
Pages (from-to)1228-1231
Number of pages4
JournalArchives of Neurology
Volume62
Issue number8
DOIs
StatePublished - Aug 1 2005

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Diffusion Magnetic Resonance Imaging
Dissection
Atherosclerosis
Brain Infarction
Infarction
Embolism
Stroke
Magnetic Resonance Imaging
Basilar Artery
Teaching Hospitals

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection. / Koch, Sebastian; Amir, Murtaza; Rabinstein, Alejandro A.; Reyes-Iglesias, Yolanda; Romano, Jose G; Forteza, Alejandro.

In: Archives of Neurology, Vol. 62, No. 8, 01.08.2005, p. 1228-1231.

Research output: Contribution to journalArticle

Koch, Sebastian ; Amir, Murtaza ; Rabinstein, Alejandro A. ; Reyes-Iglesias, Yolanda ; Romano, Jose G ; Forteza, Alejandro. / Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection. In: Archives of Neurology. 2005 ; Vol. 62, No. 8. pp. 1228-1231.
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abstract = "Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Design: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Setting: Large community-based teaching hospital. Patients: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Main Outcome Measure: Infarct patterns were analyzed according to established templates of vascular territories. Results: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72{\%}) of 11 patients with arterial dissections and 25 (64{\%}) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18{\%}) of 11 patients with dissections and 18 (46{\%}) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36{\%}) of 39 patients with atherosclerosis and 4 (37{\%}) of 11 patients with dissections (P = .6). Conclusions: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.",
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AB - Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Design: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Setting: Large community-based teaching hospital. Patients: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Main Outcome Measure: Infarct patterns were analyzed according to established templates of vascular territories. Results: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). Conclusions: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

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