Document Detail


Pathogenesis of subcortical hyperintense lesions on magnetic resonance imaging of the brain. Observations in patients undergoing controlled therapeutic internal carotid artery occlusion.
MedLine Citation:
PMID:  8362428     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Factors associated with the pathogenesis of subcortical hyperintense lesions on magnetic resonance imaging of the brain are not known. We describe four cases of de novo genesis of subcortical hyperintense lesions in patients undergoing controlled therapeutic internal carotid artery occlusion, and we speculate on associated pathophysiological mechanisms. METHODS: Twelve consecutive patients underwent controlled therapeutic internal carotid artery occlusion for symptomatic giant cerebral aneurysm using the detachable balloon technique under full anticoagulation. Preocclusion (within 2 weeks) and postocclusion (within 6 weeks) magnetic resonance imaging of the brain was performed in eight cases and evaluated for preexisting and new appearance of subcortical hyperintense lesions. RESULTS: There were four instances of de novo genesis of subcortical hyperintense lesions after carotid occlusion. New subcortical hyperintense lesions were ipsilateral to carotid occlusion in every instance and in two cases were associated with ipsilateral hemispheric ischemic symptoms despite anticoagulant therapy. In one instance, there were transient hemispheric symptoms without the appearance of new subcortical hyperintense lesions. Age, vascular risk factors, and preexisting subcortical hyperintense lesions did not appear to predispose patients to de novo genesis of new hyperintensities. CONCLUSIONS: This is the first documentation of de novo genesis of subcortical hyperintense lesions in a controlled setting of hemodynamic ischemic insult. Symptomatic and asymptomatic lesions can be detected in this setting. Anticoagulation does not appear to provide protection from this phenomenon. Careful prospective studies are required to further evaluate risk factors and possible clinical consequences associated with the genesis of new subcortical hyperintense lesions.
Authors:
I A Awad; T Masaryk; M Magdinec
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  24     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-09-27     Completed Date:  1993-09-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1339-46     Citation Subset:  IM    
Affiliation:
Section of Cerebrovascular Surgery, Cleveland Clinic Foundation, Ohio.
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MeSH Terms
Descriptor/Qualifier:
Aged
Balloon Dilatation
Brain Diseases / diagnosis*
Carotid Artery Diseases / therapy*
Carotid Artery, Internal / pathology
Cerebral Revascularization
Female
Humans
Intracranial Aneurysm / diagnosis,  therapy
Magnetic Resonance Imaging*
Male
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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