Demographic characteristics, ischemic lesion size on initial and follow-up DWI, as well as perfusion deficit size on initial PWI in patients with and without HARM.

<p>Demographic characteristics, ischemic lesion size on initial and follow-up DWI, as well as perfusion deficit size on initial PWI in patients with and without HARM.</p

Demographic characteristics, ischemic lesion size and localization on diffusion-weighted images (DWI) as well as frequency of clinical symptoms in isolated thalamic infarction patients with crossed cerebellar diaschisis (CCD) and normal PWI.

<p>Demographic characteristics, ischemic lesion size and localization on diffusion-weighted images (DWI) as well as frequency of clinical symptoms in isolated thalamic infarction patients with crossed cerebellar diaschisis (CCD) and normal PWI.</p

Two examples of crossed cerebellar diaschisis.

<p>1. A 75-year-old female patient with reduced vigilance, dysarthria, and right-sided hemihypaesthesia: <i>A</i> Trace diffusion-weighted image shows an acute ischemic lesion (arrow) in the territory of the left tuberothalamic artery with <i>B</i> matching hypoperfusion (arrow) on the time to peak (TTP) map. <i>C</i> In the cerebellum trace DWI is unremarkable while <i>D</i> TTP demonstrates hypoperfusion in the contralteral cerebellar hemisphere. 2. A 65-year-old female patient with right-sided hemiparesis: <i>E</i> Trace DWI shows an acute ischemic lesion (arrow) in the territory of the left paramedian artery with <i>F</i> minor hypoperfusion (arrow) on TTP. <i>G</i> In the cerebellum trace DWI is unremarkable while <i>H</i> TTP demonstrates hypoperfusion in the contralateral cerebellar hemisphere.</p

Anatomical distribution of cerebral microbleeds and intracerebral hemorrhage in vertebrobasilar dolichoectasia

<div><p>Objectives</p><p>Vertebrobasilar dolichoectasia (VBD) is a dilatative arteriopathy associated with intracerebral hemorrhage. In the present study, we sought to evaluate the frequency and anatomical distribution of cerebral microbleeds (cMBs) and intracerebral hemorrhage (ICH) in VBD.</p><p>Methods</p><p>From a MRI database 94 VBD patients were identified and analyzed with special emphasis on cMBs and ICH on T2*-weighted gradient echo images (GRE) in relation to the established diagnostic MRI criteria of VBD (diameter, height, and lateral position). cMBs/ICH location was categorized into anterior/posterior circulation. Clinical information like demographic details, clinical symptoms, and comorbidities were abstracted from the case records. An extensive modelling approach using generalized linear mixed-effects models was used.</p><p>Results</p><p>Overall, 79 (84.0%) patients (mean age 72.1±10.0 years, 74.7% male) with a standard stroke MRI protocol including T2*-weighted images were included in the analysis. cMBs were observed in 38/79 (48.1%) patients, ranging from 1 to 84 cMBs per patient. In the posterior circulation cMBs were observed more frequently (34/38 (89.5%)) in comparison to the anterior circulation (24/38 (63.2%)). cMBs were observed in the thalamus in 20/38 (52.6%), hippocampus in 1/38 (2.6%), occipital lobe in 18/38 (47.4%), pons in 6/38 (15.8%), medulla oblongata in 2/38 (5.2%), and cerebellum in 14/38 (36.8%) patients. ICH was observed in only 6/79 (7.6%) patients. There were significantly more cMBs in the posterior- (NCMBs-PC = 1.717, 95%CI: 1.336–2.208, p = 0.0315) than in the anterior circulation.</p><p>Logistic regression model showed a significant positive effect of clinical symptoms such as ischemic, TIA and hemorrhagic stroke on the presence of cMBs (OR = 3.34, 95%CI [2.0–5.57], p = 0.0184; ndf = 78, AIC = 107.51).</p><p>General linear model showed that clinical symptoms have a highly significant effect on the number of cMBs (N = 2.78, 95%CI [2.51–3.07], p<2*10–16; ndf = 78, AIC = 1218).</p><p>Conclusion</p><p>cMBs and ICH may be observed in the anterior and posterior circulation in VBD but they occur more frequently in the posterior circulation. Most common anatomical locations of cMBs in VBD were the thalamus, occipital lobe and cerebellum. This posterior dominance of cMBs and ICH in VBD might reflect a specific underlying vascular pathology.</p></div

Details on demographics and cerebrovascular risk factors in vertebrobasilar dolichoectasia patients with and without cMBs.

<p>Details on demographics and cerebrovascular risk factors in vertebrobasilar dolichoectasia patients with and without cMBs.</p

Three examples of perfusion patterns in acute lacunar infarction.

<p>Mismatch (1), inverse mismatch (2), and match (3) between diffusion-weighted and perfusion-weighted images (DWI, PWI). DWI (a) shows the initial ischemic lesion (white arrow). PWI derived maps demonstrate the perfusion deficit: time to peak (b), cerebral blood flow (c), and cerebral blood volume (d). Follow-up DWI (e) and FLAIR (f) show the ischemic lesion (white arrow). Note that case 2 is also an example of lesion reversal after intravenous thrombolysis.</p

The distribution of cerebral microbleeds in vertebrobasilar dolichoectasia were noted according to the to the maps by Tatu et al.

<p>[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196149#pone.0196149.ref027" target="_blank">27</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196149#pone.0196149.ref028" target="_blank">28</a>] Supratentorial: Anterior circulation (blue), and posterior circulation including occipital lobe (yellow), thalamus (red), splenium (green), and hippocampus (pink). Infratentorial: Brainstem, including mesencephalon (brown), pons (orange), and medulla oblongata (turquoise), and cerebellum (violet).</p

Example of a patient with A. VBD on TOF-MRA and B. associated intracerebral hemorrhage in the thalamus (arrow) as well as cMBs (arrow heads) in the posterior circulation on T2*-weigthed images.

<p>Example of a patient with A. VBD on TOF-MRA and B. associated intracerebral hemorrhage in the thalamus (arrow) as well as cMBs (arrow heads) in the posterior circulation on T2*-weigthed images.</p

Initial and follow-up digital subtraction angiography of a 44-year-old female patient (Table 1, #21) 8 years after bleeding.

<p><i>A</i> Right ICA angiogram (lateral view) obtained in 2005 depicting a 2 x 2 mm aneurysm of the right distal ICA <i>(arrow)</i>, which was not initially detected. <i>B</i> Pre-operative angiogram of the right ICA (lateral view) in 2013; since 2005 the morphology and extension of the distal ICA aneurysm remained stable <i>(arrow)</i>. ICA = internal carotid artery.</p

Sequence parameters of T2*-weighted images at the department’s MRI scanners.

<p>Sequence parameters of T2*-weighted images at the department’s MRI scanners.</p