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TOPIC OF THE ISSUE: NEUROIMAGE
Year : 2010  |  Volume : 58  |  Issue : 4  |  Page : 620-621

Middle cerebral artery susceptibility sign and venous prominence in acute ischemic stroke


1 Section of Neurology, Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei, Taiwan
2 Section of Neurology, Department of Medical Imaging, Far-Eastern Memorial Hospital, Taipei, Taiwan

Date of Acceptance09-Oct-2010
Date of Web Publication24-Aug-2010

Correspondence Address:
Lung Chan
Section of Neurology, Department of Internal Medicine, Far-Eastern Memorial Hospital, Taipei County
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.68672

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How to cite this article:
Yen JC, Lai YJ, Chan L. Middle cerebral artery susceptibility sign and venous prominence in acute ischemic stroke. Neurol India 2010;58:620-1

How to cite this URL:
Yen JC, Lai YJ, Chan L. Middle cerebral artery susceptibility sign and venous prominence in acute ischemic stroke. Neurol India [serial online] 2010 [cited 2019 Sep 22];58:620-1. Available from: http://www.neurologyindia.com/text.asp?2010/58/4/620/68672


A 44-year-old man visited neurology clinic for slurred speech and gait disturbance of 4 days duration. Brain magnetic resonance image (MRI) showed subacute infarction in the right middle cerebral artery (MCA) watershed territory [Figure 1]a. MR-angiography (MRA) showed truncation of right MCA indicating right MCA occlusion [Figure 1]b. MR perfusion study revealed prolongation of mean transit time in the right MCA territory with decreased relative cerebral blood flow and relative cerebral blood volume [Figure 1]c and d. Susceptibility-weighted imaging (SWI) demonstrated focal hypointensity in the right M1 segment of the MCA representing a thrombus [Figure 2]a. Accentuation of cortical venous hypointensities in the right cerebral hemisphere suggested a relative increase of deoxyhemoglobin in the draining veins within the acute ischemic region [Figure 2]b.
Figure 1 : Brain MRI. (a) Diffusion-weighted imaging showed a hyperintense lesion in the right middle cerebral internal watershed territory consistent with a recent cerebral infarction. (b) 3D time-of-flight magnetic resonance angiography showed an occlusion in the right proximal M1 middle cerebral artery (MCA). (c) In the MR relative cerebral blood volume image, decreased blood volume in the right temporal cortex and right sylvian vessels was found at the level of cerebral peduncles. (d) MR perfusion revealed a prolongation of the mean transit time in the right MCA territory

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Figure 2 : (a) Susceptibility-weighted imaging showed a focal hypointensity (arrow) in right proximal M1 middle cerebral artery owing to a thromboembolus (b) Accentuated cortical venous hypointensities (arrows) in the right cerebral hemisphere due to increase of deoxygenated blood pooling in the acute stroke

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Deoxygenated hemoglobin is paramagnetic in SWI with a hypointensity signal. The oxygenated hemoglobin is of lesser paramagnetic effect, and is iso- or hyperintense on SWI. [1] In acute thrombotic or thromboembolic stroke, decreased arterial blood flow will cause an increase in the amount of deoxyhemoglobin and deoxygenated blood pooling in tissue capillaries and draining veins. SWI will show a hypointensity signal of the cortical veins in the areas of impaired brain perfusion. [1] Furthermore, blood clots in the vessels contain high concentration of deoxyhemoglobin, which will present as a hypointensity on SWI. [2],[3] SWI is a very powerful tool in localization of the arterial occlusion and thromboembolus, even in the distal branches of cerebral arteries. [3]

 
  References Top

1.Hermier M, Nighoghossian N. Contribution of susceptibility-weighted imaging to acute stroke assessment. Stroke 2004;35:1989-94.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted Imaging: Technical aspects and clinical applications, Part 2. AJNR Am J Neuroradiol 2009;30:232-52.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Santhosh K, Kesavadas C. Susceptibility-weighted imaging: a new tool in magnetic resonance imaging of stroke. Clin Radiol 2009;64:74-83.  Back to cited text no. 3      


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