Study of highGresolution MR on the cerebral perforating artery related ischemic stroke / 实用放射学杂志

Objective To study the value of three-dimensional high-resolution magnetic resonance wall imaging (3D-HR-VWI)for ischemic stroke caused by perforating artery infarction.Methods Retrospectively studied 38 patients between 201 6 and 2018.3D-HR-VWI technique were used to examine the structures of the ipsilateral and contralateral lenticulostriate arteries of the lesion,to study the characteristics of the perforating artery lesion.Results There was no statistical significance in the absolute number of lenticulostriate arteries on the lesion side and the normal side (P＝0.251 2).There was statistical significance in the ratio of lenticulostriate arteries between two groups (P＝0.020).The differences of the depth of lenticulostriate arteries on lesion sides were also statistical significant between two groups (P＝0.032).The differences among risk factors including hypertension,diabetes,hyperlipidemia and smoking were not statistically significant.There was no statistical significance on the differences of vascular involvement,length of M1 lesions,etiological types, number of lenticulostriate arteries,and depth of lenticulostriate arteries among the lateral lenticulostriate artery group,the internal lenticulostriate artery group and the internal+lateral lenticulostriate artery group.Conclusion 3D-HR-VWI can show the lesions of lenticulostriate arteries and perforating arteries,which is of important in diagnosis of perforating artery infarction.

Analysis of Cerebral Hemorrhage Based on Microcirculation / 医用生物力学

Objective To study the effect and mechanism of capillary microcirculation disturbance on intracerebral hemorrhage. Methods The loading effect of capillaries was replaced by the introduction of porous media. A microcirculation model from the capillaries to the veins was established. The appropriate mechanical boundary conditions were set up for the model by referring to various physiological conditions of human body, and the changes in blood pressure and stress of vascular wall under various conditions were simulated. Results Under normal circumstances, the whole blood pressure of the LSA was relatively low, and the pressure difference between the beginning and the end of the LSA was more obvious, and the stress of all parts of the vascular wall was at the same level. In the case of microcirculation disorder, the whole blood pressure of the LSA increased and the pressure difference between the beginning and the end of the LSA significantly decreased. The stress for each part of the vessel increased and the stress at the end of the LSA increased most significantly. Conclusions The influence of microcirculation disturbance on hemodynamics of the LSA was particularly significant. It was an important factor leading to hemorrhage of the LSA rupture. The research findings are of important theoretical and practical significance for understanding the mechanism of cerebral vascular rupture and preventing the occurrence of cerebral hemorrhage in the case of microcirculation disturbance.

Lenticulostriate Artery Involvement is Predictive of Poor Outcomes in Superficial Middle Cerebral Artery Territory Infarction

PURPOSE: Patients with superficial middle cerebral artery (MCA) territory infarction may have concomitant lenticulostriate artery (LSA) territory infarction. We investigated the mechanisms thereof and the outcomes of patients with superficial MCA territory infarction according to the presence or absence of LSA involvement. MATERIALS AND METHODS: Consecutive patients with first-ever infarction in the unilateral superficial MCA territory were included in this study. They were divided into the superficial MCA only (SM) group and the superficial MCA plus LSA (SM+L) group. RESULTS: Of the 398 patients, 84 patients (21.1%) had LSA involvement (SM+L group). The SM+L group more frequently had significant stenosis of the proximal MCA or carotid artery and high-risk cardioembolic sources. Stroke severity and outcomes were remarkably different between the groups. The SM+L group showed more severe neurologic deficits (National Institute of Health Stroke Scale score 10.8±7.1 vs. 4.0±5.0, p2) at 3 months was more common in the SM+L group (64.3% vs. 15.9%, p<0.001). During a mean follow-up of 26 months, 67 patients died. All-cause (hazard ratio, 2.246) and stroke (hazard ratio, 9.193) mortalities were higher in the SM+L group than the SM group. In multivariate analyses, LSA involvement was an independent predictor of poor functional outcomes and stroke mortality. CONCLUSION: LSA territory involvement is predictive of poor long-term outcomes in patients with superficial MCA territory infarction.

Deep Intracerebral Hemorrhage Caused by Rupture of Distal Lenticulostriate Artery Aneurysm : A Report of Two Cases and a Literature Review

Intracerebral hemorrhage (ICH) is common among various types of storkes; however, it is rare in young patients and patients who do not have any risk factors. In such cases, ICH is generally caused by vascular malformations, tumors, vasculitis, or drug abuse. Basal ganglia ICH is rarely related with distal lenticulostriate artery (LSA) aneurysm. Since the 1960s, a total of 29 distal LSA aneurysm cases causing ICH have been reported in the English literature. Despite of the small number of cases, various treatment methods have been attempted : surgical clipping, endovascular treatment, conservative treatment, superficial temporal artery-middle cerebral artery anastomosis, and gamma-knife radiosurgery. Here, we report two additional cases and review the literature. Thereupon, we discerned that young patients with deep ICH are in need of conventional cerebral angiography. Moreover, initial conservative treatment with follow-up cerebral angiography might be a good treatment option except for cases with a large amount of hematoma that necessitates emergency evacuation. If the LSA aneurysm still persists or enlarges on follow-up angiography, it should be treated surgically or endovascularly.

Idiopathic Lenticulostriate Artery Pseudoaneurysm Protruding into the Lateral Ventricle: A Case Report

We report a rare case of an idiopathic pseudoaneurysm causing intraventricular hemorrhage (IVH). A 28-year-old man presented with sudden onset of severe headache. He underwent external ventricular drainage for an isolated IVH in the right lateral ventricle. Digital subtraction angiography (DSA) revealed that the aneurysm (7.5x4.5 mm) arose from the distal part of the medial lenticulostriate artery. Following removal of the external ventricular drainage catheter, the aneurysm decreased in size (4.0x2.3 mm). However, follow-up DSA revealed a slightly enlarged aneurysm (4.2x3.2 mm) with morphologic change. The aneurysm was clipped via the interhemispheric transcallosal approach, but postoperative DSA revealed a residual aneurysm sac beside the clips. Given the risk of rebleeding, a second operation was planned for complete resection of the aneurysm. After revised craniotomy and careful dissection of the caudate nucleus, the aneurysm sac was completely resected. Histopathological examination revealed that the aneurysm was a pseudoaneurysm. The patient recovered without any neurological sequel and was discharged. To the best of our knowledge, this is the first reported case of an idiopathic lenticulostriate artery pseudoaneurysm protruding into the right lateral ventricle and causing an IVH that was successfully treated with microsurgical resection.

Distal Lenticulostriate Artery Aneurysm Presenting With Spontaneous Intracerebral and Intraventricular Hemorrhage: A Case Report and a Review of the Literature / 대한뇌혈관외과학회지

The authors report here on a rare case of aneurysm involving the distal lenticulostriate artery (LSA) in a 66-year-old man who presented with intracerebral hemorrhage (ICH) in the right basal ganglia and also intraventricular hemorrhage (IVH). Three-dimensional computed tomography angiography (3D-CTA) and conventional cerebral angiography showed a 4 mm, round-shaped aneurysm in the right distal LSA and this was combined with moyamoya-like disease. We performed proximal clipping of the aneurysm using a microsurgical technique and we evacuated the hematoma. After the operation, there was recurrent bleeding around the operation site and hydrocephalus gradually developed, and we implanted a ventriculo-peritoneal (V-P) shunt. The patient did well after the final shunt surgery and rehabilitation. Presently, he has no motor weakness or significant neurologic deficit, but mild cognitive dysfunction remains. When spontaneous ICH occurs in an unusual site, a thorough investigation is important to rule out a structural vascular abnormality.

Analysis of the Lesion Distributions and Mechanism of Acute Middle Cerebral Artery Infarctions Involving the Striatocapsular Region

BACKGROUND AND PURPOSE: There is no clear description about the patterns of each mechanism of striatocapsular infarctions. The aims of our study were to elucidate differences in the distributions of lesions of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease. METHODS: We prospectively enrolled patients with acute infarcts located in the lenticulostriate artery territory that were not lacunar infarcts. Brain coronal diffusion-weighted imaging (DWI) was obtained and magnetic resonance angiography (MRA) was carried out to evaluate the distribution of infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into three categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE), and (3) dominant in the proximal territory. We performed tests for embolic sources (transthoracic echocardiography, transesophageal echocardiography, Holter monitoring, and contrast-enhanced MRA including the aortic arch) in most patients. Stroke mechanisms were classified into stroke from proximal embolism, MCA disease, and stroke of undetermined etiology. RESULTS: A total of 47 patients (28 men and 19 women; mean age, 62 years) were recruited. A proximal embolic source was significantly more prevalent in patients with a DE lesion than in those with a DD lesion. The most common proximal embolic source was of cardiac origin. In contrast, symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion. CONCLUSIONS: These results suggest that the dominant area of striatocapsular infarction on coronal DWI is an important clue for stroke etiology. Coronal DWI could therefore be helpful to determining the mechanisms in patients with striatocapsular infarctions that are currently described as having an "undetermined etiology" according to the Trial of Org 10172 in Acute Stroke Treatment classification.

Ruptured Distal Lenticulostriate Artery Aneurysm Associated with Ipsilateral Middle Cerebral Artery Occlusion : Case Report / 대한뇌혈관외과학회지

A 49-year-old man presented with right basal ganglia hemorrhage due to a ruptured distal lenticulostriate artery aneurysm associated with ipsilateral occlusion of M1 segment of middle cerebral artery with moyamoya-type vessels. Conservative treatment was initially selected. However, the patient suddenly became drowsy with left hemiparesis due to recurrent bleeding 14 days after admission, and excision of the aneurysm was urgently performed via right frontotemporal craniotomy. The follow-up angiography showed successful resolution of the aneurysm. This report describes a rare case of a distal lenticulostriate artery aneurysm associated with ipsilateral middle cerebral artery occlusion with moyamoya-type vessels, which resulted in intracerebral hemorrhage on the right basal ganglia and intraventricular hemorrhage.