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01-03-2005 | Neuro

Distribution territories and causative mechanisms of ischemic stroke

Authors: A. Rovira, E. Grivé, A. Rovira, J. Alvarez-Sabin

Published in: European Radiology | Issue 3/2005

Abstract

Ischemic stroke prognosis, risk of recurrence, clinical assessment, and treatment decisions are influenced by stroke subtype (anatomic distribution and causative mechanism of infarction). Stroke subtype diagnosis is better achieved in the early phase of acute ischemia with the use of multimodal MR imaging. The pattern of brain lesions as shown by brain MR imaging can be classified according to a modified Oxfordshire method, based on the anatomic distribution of the infarcts into six groups: (1) total anterior circulation infarcts, (2) partial anterior circulation infarcts, (3) posterior circulation infarcts, (4) watershed infarcts, (5) centrum ovale infarcts, and (6) lacunar infarcts. The subtype of stroke according to its causative mechanism is based on the TOAST method, which classifies stroke into five major etiologic groups: (1) large-vessel atherosclerotic disease, (2) small-vessel atherosclerotic disease, (3) cardioembolic source, (4) other determined etiologies, and (5) undetermined or multiple possible etiologies. The different MR imaging patterns of acute ischemic brain lesions visualized using diffusion-weighted imaging and the pattern of vessel involvement demonstrated with MR angiography are essential factors that can suggest the most likely causative mechanism of infarction. This information may have an impact on decisions regarding therapy and the performance of additional diagnostic tests.

Bamford J, Sandercock P, Dennis M et al (1991) Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337:1521–1526CrossRefPubMed

Tei H, Uchiyama S, Ohara K, Kobayashi M, Uchiyama Y, Fukuzawa M (2000) Deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project. Stroke 31:2049–2054

Adams HP, Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke: definitions for use in a Multicenter Clinical Trial. Stroke 24:35–41PubMed

Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU (2001) Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 32:2735–2740PubMed

Lee LJ, Kidwell CS, Alger J et al (2000) Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Stroke 31:1081–1089

van der Zwan A, Hillen B, Tulleken CA, Dujovny M, Dragovic L (1992) Variability of the territories of the major cerebral arteries. J Neurosurg 77:927–940

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

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

Hupperts RM, Lodder J, Heuts-van Raak EP, Kessels F (1994) Infarcts in the anterior choroidal artery territory: anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome. Brain 117:825–834

10.

Takahashi S, Suzuki M, Matsumoto K, Ishii K, Higano S, Fukasawa H, Sakamoto K (1994) Extent and location of cerebral infarcts on multiplanar MR images: correlation with distribution of perforating arteries on cerebral angiograms and on cadaveric microangiograms. Am J Roentgenol 163:1215–1222

11.

Heinsius T, Bogousslavsky J, Van Melle G (1998) Large infarcts in the middle cerebral artery territory: etiology and outcome patterns. Neurology 50:341–350

12.

Oppenheim C, Samson Y, Manai R, Lalam T, Vandamme X, Crozier S, Srour A, Cornu P, Dormont D, Rancurel G, Marsault C (2000) Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke 31:2175–2181

13.

Georgiadis D, Schwarz S, Aschoff A, Schwab S (2002) Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke 33:1584–1588CrossRef

14.

Min WK, Kim YS, Kim JY, Park SP, Suh CK (1999) Atherothrombotic cerebellar infarction: vascular lesion–MRI correlation of 31 cases. Stroke 30:2376–2381

15.

Amarenco P, Kase CS, Rosengart A, Pessin MS, Bousser MG, Caplan LR (1993) Very small (border zone) cerebellar infarcts: distribution, causes, mechanisms and clinical features. Brain 116:161–186

16.

Amarenco P, Levy C, Cohen A, Touboul PJ, Roullet E, Bousser MG (1994) Causes and mechanisms of territorial and nonterritorial cerebellar infarcts in 115 consecutive patients. Stroke 25:105–112

17.

Bogousslavsky J, Regli F (1992) Centrum ovale infarcts: subcortical infarction in the superficial territory of the middle cerebral artery. Neurology 42:1992–1998

18.

Yonemura K, Kimura K, Minematsu K, Uchino M, Yamaguchi T (2002) Small centrum ovale infarcts on diffusion-weighted magnetic resonance imaging. Stroke 33:1541–1544CrossRef

19.

Bogousslavsky J, Regli F (1986) Borderzone infarctions distal to internal carotid artery occlusion: prognostic implications. Ann Neurol 20:346–350CrossRef

20.

Belden JR, Caplan LR, Pessin MS, Kwan E (1999) Mechanisms and clinical features of posterior border-zone infarcts. Neurology 53:1312–1318

21.

Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ (2000) Internal borderzone infarction: a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group. Stroke 3:631–636

22.

Boiten J, Lodder J, Kessels F (1993) Two clinically distinct lacunar infarct entities? A hypothesis. Stroke 24:652–656

23.

de Jong G, Kessels F, Lodder J (2002) Two types of lacunar infarcts: further arguments from a study on prognosis. Stroke 33:2072–2076CrossRef

24.

Lodder J, Bamford JM, Sandercock PA, Jones LN, Warlow CP (1990) Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke 21:375–381

25.

Roh JK, Kang DW, Lee SH, Yoon BW, Chang KH (2000) Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke 31:688–694

26.

Baird AE, Lovblad KO, Schlaug G, Edelman RR, Warach S (2000) Multiple acute stroke syndrome: marker of embolic disease? Neurology 54:674–678

27.

Min WK, Park KK, Kim YS, Park HC, Kim JY, Park SP, Suh CK (2000) Atherothrombotic middle cerebral artery territory infarction: topographic diversity with common occurrence of concomitant small cortical and subcortical infarcts. Stroke 31:2055–2061PubMed

28.

Szabo K, Kern R, Gass A, Hirsch J, Hennerici M (2001) Acute stroke patterns in patients with internal carotid artery disease: a diffusion-weighted magnetic resonance imaging study. Stroke 32:1323–1329

29.

Arauz A, Murillo L, Cantu C, Barinagarrementeria F, Higuera J (2003) Prospective study of single and multiple lacunar infarcts using magnetic resonance imaging: risk factors, recurrence, and outcome in 175 consecutive cases. Stroke 34:2453–2458CrossRef

30.

Hart RG, Halperin JL (2001) Atrial fibrillation and stroke: concepts and controversies. Stroke 32:803–808PubMed

31.

Timsit SG, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA, Price TR, Hier DB (1993) Brain infarction severity differs according to cardiac or arterial embolic source. Neurology 43:728–733

Title: Distribution territories and causative mechanisms of ischemic stroke
Authors: A. Rovira
E. Grivé
A. Rovira
J. Alvarez-Sabin
Publication date: 01-03-2005
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2005
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-004-2633-5

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Distribution territories and causative mechanisms of ischemic stroke

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