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Cortex-sparing infarctions in patients with occlusion of the middle cerebral artery

 Han Jin Cho  ;  Jae Hoon Yang  ;  Yo Han Jung  ;  Young Dae Kim  ;  Hye-Yeon Choi  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
 Journal of Neurology, Neurosurgery and Psychiatry, Vol.81(8) : 859-863, 2010 
Journal Title
 Journal of Neurology, Neurosurgery and Psychiatry 
Issue Date
Age Factors ; Aged ; Arterial Occlusive Diseases/pathology* ; Atherosclerosis/complications ; Brain Ischemia/complications ; Brain Ischemia/pathology ; Cerebral Arteries/pathology ; Cerebral Cortex/pathology* ; Diffusion Magnetic Resonance Imaging ; Embolism/complications ; Female ; Humans ; Infarction, Middle Cerebral Artery/pathology* ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Stroke/classification ; Stroke/etiology ; Stroke/pathology ; Thrombolytic Therapy
BACKGROUND: In patients with a middle cerebral artery (MCA) occlusion, the involvement of the cortex may be affected by the presence of leptomeningeal anastomoses between the cerebral arteries. METHODS: The authors enrolled consecutive patients with acute infarctions in the MCA territory and MCA occlusion on angiographic studies. Infarct patterns were classified into three categories based on the extent of cortical surface involvement: total cortex (TC), partial cortex (PC) and no cortex (NC). The authors analysed the infarction patterns by stroke subtype, and investigated factors that resulted in cortex sparing. RESULTS: Out of 73 total patients, cortex-sparing infarctions were seen in 53 patients (72.6%, NC in 39 (53.5%) and PC in 14 (19.1%)). The extent of cortical involvement differed according to stroke subtype (p=0.036). TC was more frequent (42.9% vs 22.2%), and PC was less frequent (10.7% vs 27.9%, p=0.037) in cardioembolism than large-artery atherosclerosis. However, the proportion of patients with complete cortical sparing (NC) was similar between cardioembolism and large-artery atherosclerosis (46.4% vs 49.9%). In the upstream of leptomeningeal collateral arteries, the extent of cortical involvement was associated with significant stenosis of the ipsilateral anterior or posterior cerebral artery (p=0.011). CONCLUSION: This study suggests that pre-existing arteriolar connections, which may cover almost entire cortical surfaces of the MCA territory, exist in many patients. The findings also suggest that the extent of cortical involvement is different between stroke subtypes, and is critically affected by the status of upstream collateral arteries.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Yang, Jae Hoon(양재훈)
Jung, Yo Han(정요한)
Cho, Han Jin(조한진)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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