Document Detail

Radiological reasoning: extracranial causes of unilateral decreased brain perfusion.
MedLine Citation:
PMID:  18029901     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A 50-year-old man presented with neurologic symptoms and upper extremity claudication associated with exercise. Perfusion MRI of the brain showed delayed time-to-peak in the right cerebral hemisphere, and MR angiography (MRA) of the circle of Willis showed decreased flow-related enhancement in the right internal carotid artery and its branches. Neck MRA showed occlusion of the right innominate (brachiocephalic) artery and retrograde flow in the ipsilateral vertebral artery. On the basis of this clinical scenario, we discuss the radiologic evaluation of unilateral decreased brain perfusion, which, in this case, was due to an occlusion of the innominate artery with resultant innominate steal.
CONCLUSION: In the absence of an explanatory intracranial stenosis, the finding of unilateral decreased cerebral perfusion on MRI or CT mandates evaluation of the aortic arch and cervical arteries to determine a level and cause of occlusion. Severe stenoses may be associated with steal phenomena, which can be diagnosed with MRA or Doppler sonography.
Benjamin Y Huang; Mauricio Castillo
Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  189     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-21     Completed Date:  2008-02-26     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S49-54     Citation Subset:  AIM; IM    
Department of Radiology, University of North Carolina at Chapel Hill, CB #7510, 101 Manning Drive, Chapel Hill, NC 27599-7510, USA.
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MeSH Terms
Arterial Occlusive Diseases / complications*,  diagnosis*,  therapy
Brachiocephalic Trunk*
Magnetic Resonance Angiography
Middle Aged
Subclavian Steal Syndrome / diagnosis,  etiology*,  therapy

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