Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter?
Border zone infarcts
Convexal subarachnoid hemorrhage
Embolism
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
24
11
2018
accepted:
23
03
2019
pubmed:
3
4
2019
medline:
14
1
2020
entrez:
3
4
2019
Statut:
ppublish
Résumé
Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear. Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA). All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection. We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.
Sections du résumé
BACKGROUND
BACKGROUND
Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear.
METHODS
METHODS
Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA).
RESULTS
RESULTS
All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection.
CONCLUSIONS
CONCLUSIONS
We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.
Identifiants
pubmed: 30937557
doi: 10.1007/s10072-019-03868-6
pii: 10.1007/s10072-019-03868-6
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1419-1424Références
J Neurol. 2009 Apr;256(4):669-71
pubmed: 19401805
Neurology. 2010 Mar 16;74(11):893-9
pubmed: 20231664
Neurology. 2010 Apr 27;74(17):1346-50
pubmed: 20421578
Eur J Neurol. 2011 Feb;18(2):e28-9
pubmed: 20868466
Stroke. 2011 Nov;42(11):3055-60
pubmed: 21921284
J Neurol Neurosurg Psychiatry. 2012 Aug;83(8):771-5
pubmed: 22696583
J Stroke Cerebrovasc Dis. 2014 Jan;23(1):e23-30
pubmed: 24119619
Stroke. 2014 Apr;45(4):1151-3
pubmed: 24496391
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1564-70
pubmed: 24630829
Emerg Radiol. 2015 Apr;22(2):181-95
pubmed: 25001597
J Neurol Sci. 2015 Jan 15;348(1-2):259-61
pubmed: 25498843
Cerebrovasc Dis. 2015;40(1-2):45-51
pubmed: 26088185
J Cerebrovasc Endovasc Neurosurg. 2016 Sep;18(3):271-275
pubmed: 27847773
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):e195-e196
pubmed: 28780251
J Cereb Blood Flow Metab. 2018 Feb;38(2):225-229
pubmed: 29168672