Document Detail

Simultaneous occurrence and interaction of hypoperfusion and embolism in a patient with severe middle cerebral artery stenosis.
MedLine Citation:
PMID:  19498193     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The coincidence of hemodynamic and embolic findings in patients with stroke from large artery stenosis has suggested an interaction of both pathologies. This has emerged into the hypothesis of an impaired washout of emboli in the presence of hypoperfusion. We propose an additional link between both pathologies. SUMMARY OF CASE: A 48-year-old woman presented with a recurrent symptomatic severe left middle cerebral artery stenosis. MRI depicted left hemispheric ischemic infarcts in the deep and subcortical white matter and in the cortical border zone. One-hour transcranial Doppler monitoring detected 64 microembolic signals distal to the arterial stenosis. Monitoring also revealed recurrent thrombus formation at the stenotic plaque with decline of poststenotic flow velocity followed by embolism with abrupt excessive flow velocity increase and subsequent normalization at the initial baseline level. Cerebrovascular reserve in the distribution territory of the stenosed artery as assessed by transcranial Doppler after carbon dioxide stimulation revealed a normal reserve capacity in periods with baseline poststenotic flow velocity and an exhausted reserve capacity when flow velocity was decreased due to stenotic thrombus formation. CONCLUSIONS: In our patient, adherent thrombus formation resulted in an increasing severity of the stenosis with subsequent vasodilatation and diminution of flow resistance in the depending vascular distribution territory. MRI suggested that adherent thrombi were predominantly washed into terminal supply and border zone brain regions, ie, into regions with supposed maximum vasodilatation and least flow resistance immediately before thrombus avulsion. Preferred wash-in of emboli into regions with low blood flow resistance might be an additional mechanism besides impaired washout in patients with severe large artery disease.
Stefanie Schreiber; Mine Serdaroglu; Frank Schreiber; Martin Skalej; Hans-Jochen Heinze; Michael Goertler
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-06-04
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-30     Completed Date:  2009-07-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e478-80     Citation Subset:  IM    
Department of Neurology, University of Magdeburg, Magdeburg, Germany.
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MeSH Terms
Blood Flow Velocity / physiology
Cerebral Arterial Diseases / complications*,  diagnosis*,  physiopathology
Constriction, Pathologic / complications,  diagnosis,  physiopathology
Infarction, Middle Cerebral Artery / complications*,  diagnosis*,  physiopathology
Magnetic Resonance Imaging
Middle Aged
Middle Cerebral Artery / pathology,  physiopathology*,  ultrasonography
Pulsatile Flow / physiology
Regional Blood Flow / physiology
Ultrasonography, Doppler, Transcranial
Vascular Resistance / physiology
Vasodilation / physiology

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

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