Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients.
Adult
Aged
Aged, 80 and over
Brain Ischemia
/ diagnostic imaging
Carotid Artery, Internal
/ diagnostic imaging
Cerebellum
/ blood supply
Cohort Studies
Female
Hemodynamics
/ physiology
Humans
Ischemic Stroke
/ diagnostic imaging
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Oxygen Consumption
/ physiology
Prospective Studies
BOLD MRI
Cerebrovascular reserve
Crossed cerebellar diaschisis
Duplex sonography
ICA occlusion
Journal
Translational stroke research
ISSN: 1868-601X
Titre abrégé: Transl Stroke Res
Pays: United States
ID NLM: 101517297
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
23
01
2020
accepted:
11
05
2020
revised:
21
04
2020
pubmed:
9
6
2020
medline:
10
11
2021
entrez:
8
6
2020
Statut:
ppublish
Résumé
Crossed cerebellar diaschisis (CCD) in internal carotid artery (ICA) stroke refers to attenuated blood flow and energy metabolism in the contralateral cerebellar hemisphere. CCD is associated with an interruption of cerebro-cerebellar tracts, but the precise mechanism is unknown. We hypothesized that in patients with ICA occlusions, CCD might indicate severe hemodynamic impairment in addition to tissue damage. Duplex sonography and clinical data from stroke patients with unilateral ICAO who underwent blood oxygen-level-dependent MRI cerebrovascular reserve (BOLD-CVR) assessment were analysed. The presence of CCD (either CCD+ or CCD-) was inferred from BOLD-CVR. We considered regions with negative BOLD-CVR signal as areas suffering from hemodynamic steal. Twenty-five patients were included (11 CCD+ and 14 CCD-). Stroke deficits on admission and at 3 months were more severe in the CCD+ group. While infarct volumes were similar, CCD+ patients had markedly larger BOLD steal volumes than CCD- patients (median [IQR] 122.2 [111] vs. 11.6 [50.6] ml; p < 0.001). Furthermore, duplex revealed higher peak-systolic flow velocities in the intracranial collateral pathways. Strikingly, posterior cerebral artery (PCA)-P2 velocities strongly correlated with the National Institute of Health Stroke Scale on admission and BOLD-CVR steal volume. In patients with strokes due to ICAO, the presence of CCD indicated hemodynamic impairment with larger BOLD-defined steal volume and higher flow in the ACA/PCA collateral system. Our data support the concept of a vascular component of CCD as an indicator of hemodynamic failure in patients with ICAO.
Identifiants
pubmed: 32506367
doi: 10.1007/s12975-020-00821-0
pii: 10.1007/s12975-020-00821-0
pmc: PMC7803723
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
39-48Subventions
Organisme : Universität Zürich
ID : CRPP Stroke
Pays : International
Organisme : Universität Zürich
ID : Forschungskredit FK-16-040
Pays : International
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
ID : PP00P3-170683
Pays : International
Organisme : Krebsforschung Schweiz
ID : KFS-3975-082016-R
Pays : International
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