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Focal laminar cortical infarcts following aneurysmal subarachnoid haemorrhage

  • Diagnostic Neuroradiology
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Abstract

Introduction

The aim of this prospective study was to analyse small band-like cortical infarcts after subarachnoid haemorrhage (SAH) using magnetic resonance imaging (MRI) with reference to additional digital subtraction angiography (DSA).

Methods

In a 5-year period between January 2002 and January 2007 10 out of 188 patients with aneurysmal SAH were evaluated (one patient Hunt and Hess grade I, one patient grade II, four patients grade III, two patients grade IV, and two patients grade V). The imaging protocol included serially performed MRI with diffusion- and perfusion-weighted images (DWI/PWI) at three time points after aneurysm treatment, and cerebral vasospasm (CVS) was analysed on follow-up DSA on day 7±3 after SAH.

Results

The lesions were located in the frontal lobe (n=10), in the insular cortex (n=3) and in the parietal lobe (n=1). The band-like infarcts occurred after a mean time interval of 5.8 days (range 3–10 days) and showed unexceptional adjacent thick sulcal clots. Seven out of ten patients with cortical infarcts had no or mild CVS, and in the remaining three patients DSA disclosed moderate (n=2) or severe (n=1) CVS.

Conclusion

The infarct pattern after aneurysmal SAH includes cortical band-like lesions. In contrast to territorial infarcts or lacunar infarcts in the white matter which develop as a result of moderate or severe proximal and/or distal vasospasm visible on angiography, the cortical band-like lesions adjacent to sulcal clots may also develop without evidence of macroscopic vasospasm, implying a vasospastic reaction of the most distal superficial and intraparenchymal vessels.

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References

  1. Dorsch NW, King MT (1994) A review of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Part I. Incidence and effects. J Clin Neurosci 1:19–24

    Article  PubMed  CAS  Google Scholar 

  2. Macdonald RL, Weir BK (eds) (2001) Cerebral vasospasm. Academic Press, San Diego

    Google Scholar 

  3. Kassell NF, Sasaki T, Colohan AR, Nazar G (1985) Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16:562–572

    PubMed  CAS  Google Scholar 

  4. Weir B, Grace M, Hansen J, Rothberg C (1978) Time course of vasospasm in man. J Neurosurg 48:173–178

    PubMed  CAS  Google Scholar 

  5. Rabinstein AA, Weigand S, Atkinson JLD, Wijdicks EFM (2005) Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 36:992–997

    Article  PubMed  Google Scholar 

  6. Fiebach JB, Schellinger PD, Geletneky K, Wilde P, Meyer M, Hacke W, Sartor K (2004) MRI in acute subarachnoid hemorrhage; findings with a standardized stroke protocol. Neuroradiology 46:44–48

    Article  PubMed  CAS  Google Scholar 

  7. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1996) Arterial territories of the human brain: brainstem and cerebellum. Neurology 47:1125–1135

    PubMed  CAS  Google Scholar 

  8. Tatu L, Moulin T, Bogousslavsky J, Duvernoy H (1998) Arterial territories of the human brain: cerebral hemispheres. Neurology 50:1699–1708

    PubMed  CAS  Google Scholar 

  9. Weidauer S, Lanfermann H, Raabe A, Zanella F, Seifert V, Beck J (2007) Impairment of cerebral perfusion and infarct patterns due to vasospasm following aneurysmal subarachnoid hemorrhage: a prospective MRI and DSA study. Stroke 38:1831–1836

    Article  PubMed  Google Scholar 

  10. Lövblad KO, Wetzel SG, Somon T, Wilhelm K, Mehdizade A, Kelekis A, El-Koussy M, El-Tatawy S, Bishof M, Schroth G, Perrig S, Lazeyras F, Sztajzel R, Terrier F, Rüfenacht D, Delavelle J (2004) Diffusion-weighted MRI in cortical ischemia. Neuroradiology 46:175–182

    Article  PubMed  Google Scholar 

  11. Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R (2001) Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery 49:1341–1350

    Article  PubMed  CAS  Google Scholar 

  12. Busch E, Beaulieu C, de Crespigny A, Moseley ME (1998) Diffusion MR imaging during acute subarachnoid hemorrhage in rats. Stroke 29:2155–2161

    PubMed  CAS  Google Scholar 

  13. Leclerc X, Fichten A, Gauvrit JY, Riegel B, Steinling M, Lejeune JP, Pruvo JP (2002) Symptomatic vasospasm after subarachnoid hemorrhage: assessment of brain damage by diffusion and perfusion-weighted MRI and single-photon emission computed tomography. Neuroradiology 44:610–616

    Article  PubMed  CAS  Google Scholar 

  14. Rordorf G, Koroshetz WJ, Copen WA, Gonzalez G, Yamada K, Schaefer PW, Schwamm LH, Ogilvy CS, Sorensen AG (1999) Diffusion- and perfusion-weighted imaging in vasospasm after subarachnoid hemorrhage. Stroke 30:599–605

    PubMed  CAS  Google Scholar 

  15. Cronqvist M, Wirestam R, Ramgren B, Brandt L, Nilsson O, Säveland H, Holtås S, Larsson EM (2005) Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome. Neuroradiology 47:855–873

    Article  PubMed  CAS  Google Scholar 

  16. Hohlrieder M, Spiegel M, Hinterhoelzl J, Engelhardt K, Pfausler B, Kampfl A, Ulmer H, Waldenberger P, Mohsenipour I, Schmutzardt E (2002) Cerebral vasospasm and ischemic infarction in clipped and coiled intracranial aneurysm patients. Eur J Neurol 9:389–399

    Article  PubMed  CAS  Google Scholar 

  17. Uhl E, Lehmberg J, Steiger HJ, Messmer K (2003) Intraoperative detection of early microvasospasm in patients with subarachnoid hemorrhage by using orthogonal polarization spectral imaging. Neurosurgery 52:1307–1315

    Article  PubMed  Google Scholar 

  18. Ohkuma H, Itoh K, Shibata S, Suzuki S (1997) Morphological changes of intraparenchymal arterioles following experimental subarachnoid hemorrhage in dogs. Neurosurgery 41:230–236

    Article  PubMed  CAS  Google Scholar 

  19. Ohkuma H, Manabe H, Tanaka M, Suzuki S (2000) Impact of cerebral microcirculatory changes on cerebral blood flow during cerebral vasospasm after subarachnoid hemorrhage. Stroke 31:1621–1627

    PubMed  CAS  Google Scholar 

  20. Sehba FA, Mostafa G, Friedrich V, Bederson JB (2005) Acute microvascular platelet aggregation after subarachnoid hemorrhage. J Neurosurg 102:1094–1100

    PubMed  Google Scholar 

  21. Dreier JP, Ebert N, Priller J, Megow D, Lindauer U, Klee R, Reuter U, Imai Y, Einhäupl KM, Victorov I, Dirnagl U (2000) Products of hemolysis in the subarachnoid space inducing spreading ischemia in the cortex and focal necrosis in rats: a model of delayed ischemic neurological deficits after subarachnoid hemorrhage? J Neurosurg 93:658–666

    PubMed  CAS  Google Scholar 

  22. Stoltenburg-Didinger G, Schwartz K (1987) Brain lesions secondary to subarachnoid hemorrhage due to ruptured aneurysms. In: Cervos-Navarro J, Ferst R (eds) Stroke and microcirculation. Raven Press, New York, pp 471–480

    Google Scholar 

  23. Nagai H, Katsumata T, Ohya M, Kageyama N (1976) Effect of subarachnoid hemorrhage on microcirculation in hypothalamus and brain stem of dogs. Neurochirurgia 19:135–144

    PubMed  CAS  Google Scholar 

  24. Wiernsperger N, Schulz U, Gygax P (1981) Physiological and morphometric analysis of the microcirculation of the cerebral cortex under acute vasospasm. Stroke 12:624–627

    PubMed  CAS  Google Scholar 

  25. Nihei H, Kassell NF, Dougherty DA, Sasaki T (1991) Does vasospasm occur in small pial arteries and arterioles of rabbits? Stroke 22:1419–1425

    PubMed  CAS  Google Scholar 

  26. Ohkuma H, Suzki S (1999) Histological dissociation between intra- and extraparenchymal portion of perforating small arteries after experimental subarachnoid hemorrhage in dogs. Acta Neuropathol 98:374–382

    Article  PubMed  CAS  Google Scholar 

  27. Hart MN (1980) Morphometry of brain parenchyma vessels following subarachnoid hemorrhage. Stroke 11:653–655

    PubMed  CAS  Google Scholar 

  28. Dreier JP, Sakowitz OW, Harder A, Zimmer C, Dirnagl U, Valdueza JM, Unterberg AW (2002) Focal laminar cortical MR signal abnormalities after subarachnoid hemorrhage. Ann Neurol 52:825–829

    Article  PubMed  Google Scholar 

  29. Ito H (1978) A clinical study on vasospasm following subarachnoid hemorrhage using the ratio of inner diameters of cerebral arteries to the ganglionic portion of internal carotid artery. Brain Nerve 30:795–804

    PubMed  CAS  Google Scholar 

  30. Greitz T (1968) Normal cerebral circulation time as determined by carotid angiography with sodium and methylglucamine (Urographin). Acta Radiol Diagn 7:331–336

    CAS  Google Scholar 

  31. Okada Y, Shima T, Nishida M, Yamane K, Okita S, Hatayama T, Yoshida A, Naoe Y, Shiga N (1994) Evaluation of angiographic delayed vasospasm due to ruptured aneurysm in comparison with cerebral circulation time measured by IA- DSA. No Shinkei Geka 22:439–445

    PubMed  CAS  Google Scholar 

  32. Beck J, Raabe A, Lanfermann H, Berkefeld J, du Mesnil de Rochemont R, Zanella F, Seifert V, Weidauer S (2006) Effects of balloon angioplasty on perfusion- and diffusion-weighted magnetic resonance imaging results and outcome in patients with cerebral vasospasm. J Neurosurg 105:220–227

    PubMed  Google Scholar 

  33. Grote E, Hassler W (1988) The critical first minutes after subarachnoid hemorrhage. Neurosurgery 22:654–661

    Article  PubMed  CAS  Google Scholar 

  34. Siskas N, Lefkopoulos A, Ioannidis I, Charitandi A, Dimitriadis AS (2003) Cortical laminar necrosis in brain infarcts: serial MRI. Neuroradiology 45:283–288

    PubMed  CAS  Google Scholar 

  35. Flacke S, Wullner U, Keller E, Hamzei F, Urbach H (2000) Reversible changes in echo planar perfusion- and diffusion-weighted MRI in status epilepticus. Neuroradiology 42:92–95

    Article  PubMed  CAS  Google Scholar 

  36. Yundt KD, Grubb RL, Diringer MN, Powers WJ (1998) Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm. J Cereb Blood Flow Metab 18:419–424

    Article  PubMed  CAS  Google Scholar 

  37. Grubb RL, Raichle ME, Eichling JO, Gado MH (1977) Effects of subarachnoidal hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg 44:446–452

    Google Scholar 

  38. Vajkoczy P, Horn P, Thome C, Munch E, Schmiedek P (2003) Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia following aneurysmal subarachnoid hemorrhage. J Neurosurg 98:1227–1234

    Article  PubMed  Google Scholar 

  39. Jacobson M, Overgaard J, Marcussen E, Enevoldsen E (1990) Relation between angiographic cerebral vasospasm and regional CBF in patients with SAH. Acta Neurol Scand 82:109–115

    Article  Google Scholar 

  40. Neumann-Haefelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz R, Mödder U, Freund HJ (1999) Diffusion- and perfusion-weighted MRI: the DWI/PWI mismatch region in acute stroke. Stroke 30:1591–1597

    PubMed  CAS  Google Scholar 

  41. Thijs VN, Adami A, Neumann-Haefelin T, Moseley ME, Marks MP, Albers GW (2001) Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology 57:1205–1211

    PubMed  CAS  Google Scholar 

  42. Hertel F, Walter C, Bettag M, Mörsdorf M (2005) Perfusion-weighted magnetic resonance imaging in patients with vasospasm: a useful new tool in the management of patients with subarachnoid hemorrhage. Neurosurgery 56:28–35

    PubMed  Google Scholar 

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Stefan Weidauer, Heinrich Lanfermann & Friedhelm Zanella

  2. Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany

    Hartmut Vatter, Jürgen Beck, Andreas Raabe & Volker Seifert

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  1. Stefan Weidauer
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  2. Hartmut Vatter
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  3. Jürgen Beck
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  4. Andreas Raabe
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  5. Heinrich Lanfermann
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  7. Friedhelm Zanella
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Correspondence to Stefan Weidauer.

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Weidauer, S., Vatter, H., Beck, J. et al. Focal laminar cortical infarcts following aneurysmal subarachnoid haemorrhage. Neuroradiology 50, 1–8 (2008). https://doi.org/10.1007/s00234-007-0294-1

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  • DOI: https://doi.org/10.1007/s00234-007-0294-1

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