Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction

Ahmed Elsadek,Ahmed Gaber,Hossam Afifi,Nouran Salaheldien,Sherin Farag

doi:10.1186/s41983-018-0045-8

Ahmed Elsadek, Ahmed Gaber + Show 3 more

Open Access

https://doi.org/10.1186/s41983-018-0045-8

Copy DOI

Abstract

BackgroundBrain perfusion is most likely to be impaired in border zone regions, and clearance of emboli will be most impaired in these regions of least blood flow. Severe occlusive disease of the internal carotid artery causes both embolization and decreased perfusion as well as some cardiac diseases that cause microembolization.ObjectivesTo differentiate between hypoperfusion and microemboli as etiology of acute ischemic stroke in watershed zone.Subject and methodsFifty patients of acute ischemic stroke in watershed zones were recruited within 7 days from stroke onset. Methods used were transcranial Doppler (TCD) monitoring for the intracranial vessels to detect microembolic signals and magnetic resonance imaging (MRI) perfusion image to detect hypoperfusion signs.ResultsWe detect embolic causes of watershed infarction (WSI) by using TCD with 61.1% sensitivity and 84.4% specificity and hypoperfusion causes of WSI by using MRI perfusion studies with 94.9% sensitivity and 54.5% specificity.ConclusionWe detected the etiology of WSI, either embolic by using TCD or hypoperfusion by using MRI perfusion. The embolic causes of WSI usually cause external or mixed WSI, and hypoperfusion causes of WSI cause internal WSI.

Highlights

Watershed strokes are named because they affect the distal watershed areas of the brain
We detected the etiology of watershed infarction (WSI), either embolic by using transcranial Doppler (TCD) or hypoperfusion by using magnetic resonance imaging (MRI) perfusion
Among the 42 patients with hypoperfusion signs, 22 patients (52.4%) had carotid plaque in the cervical Internal carotid artery (ICA). These results indicate that patients who had carotid plaques are more liable to develop hypoperfusion WSI

Summary

Introduction

Watershed strokes are named because they affect the distal watershed areas of the brain. The term “watershed” refers to those areas of the brain that receive dual blood supply from the branching ends of two large arteries [1] These events are localized to two primary regions of the brain: Cortical watershed strokes (CWS), or outer brain infarcts, are located between the cortical territories of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA). Because perfusion is most likely to be impaired in border zone regions, clearance of emboli will be most impaired in these regions of least blood flow. Brain perfusion is most likely to be impaired in border zone regions, and clearance of emboli will be most impaired in these regions of least blood flow. Severe occlusive disease of the internal carotid artery causes both embolization and decreased perfusion as well as some cardiac diseases that cause microembolization

Objectives

Results

Discussion

Conclusion