Predisposing factors in posterior circulation infarcts: a vascular morphological assessment.

INTRODUCTION: The aim of the study is to assess the effect of shape, diameter, elongation and deviation criteria of basilar artery (BA), convergence angle and diameter variations of vertebral arteries, and concurrent chronic diseases on posterior circulation infarcts. METHODS: Between January 2010 and May 2013, 186 patients who underwent brain and diffusion magnetic resonance imaging (MRI) with suspected cerebrovascular accident and were diagnosed with posterior circulation infarct and 120 infarct negative control subjects were included in this case-control retrospective study. Vertebral artery (VA) and BA diameter, right (R) and left (L) VA angles at the level of bifurcation, and BA elongation-deviation, and shape of BA were assessed in a total of 306 subjects. Ischemic lesions in the posterior circulation were classified according to their anatomical location and vascular perfusion areas. RESULTS: No significant difference was noted between the control and patient groups with respect to BA diameter (p = 0.676). The most effective risk factors for posterior circulation infarcts were as follows: BA elongation of 2 or 3, BA transverse location of 2 or 3, increase in left VA angle, and history of hypertension, hypercholesterolemia, and diabetes mellitus. CONCLUSION: Our results suggest that prominent elongation and deviation, C and J shape of BA, and increased L VA angle may be the predictors of at-risk patients in posterior circulation infarcts. Reporting marked morphological BA and VA variations detected at routine brain MRI will aid in selection of patients. Timely detection and treatment of at-risk patients may be life-saving.

In vivo assessment of rapid cerebrovascular morphological adaptation following acute blood flow increase.

OBJECT: Pathological extremes in cerebrovascular remodeling may contribute to basilar artery (BA) dolichoectasia and fusiform aneurysm development. Factors regulating cerebrovascular remodeling are poorly understood. To better understand hemodynamic influences on cerebrovascular remodeling, we examined BA remodeling following common carotid artery (CCA) ligation in an animal model. METHODS: Rabbits were subjected to sham surgery (3 animals), unilateral CCA ligation (3 animals), or bilateral CCA ligation (5 animals). Transcranial Doppler ultrasonography and rotational angiography were used to compute BA flow, diameter, wall shear stress (WSS), and a tortuosity index on Days 0, 1, 4, 7, 14, 28, 56, and 84. Basilar artery tissues were stained and analyzed at Day 84. Statistical analysis was performed using orthogonal contrast analysis, repeated measures analysis of variance, or mixed regression analysis of repeated measures. Statistical significance was defined as a probability value < 0.05. RESULTS: Basilar artery flow and diameter increased significantly after the procedure in both ligation groups, but only the bilateral CCA ligation group demonstrated significant differences between groups. Wall shear stress significantly increased only in animals in the bilateral CCA ligation group and returned to baseline by Day 28, with 52% of WSS correction occurring by Day 7. Only the bilateral CCA ligation group developed significant BA tortuosity, occurring within 7 days postligation. Unlike the animals in the sham and unilateral CCA ligation groups, the animals in the bilateral CCA ligation group had histological staining results showing a substantial internal elastic lamina fragmentation. CONCLUSIONS: Increased BA flow results in adaptive BA remodeling until WSS returns to physiological baseline levels. Morphological changes occur rapidly following flow alteration and do not require chronic insult to affect substantial and significant structural transformation. Additionally, it appears that there exists a flow-increase threshold that, when surpassed, results in significant tortuosity.

Quantitative assessment of mixed cerebral vascular territory supply with vessel encoded arterial spin labeling MRI.

BACKGROUND AND PURPOSE: Recent advances in arterial spin labeling MRI have permitted noninvasive evaluation of vascular territories. In the present study, we quantitatively assess mixing of internal carotid and basilar artery blood through cerebrovascular anastomoses using vessel-encoded arterial spin labeling and a new postprocessing method. METHODS: Vessel-encoded arterial spin labeling was used to determine the territories of the internal carotid and basilar arteries in 14 healthy subjects and one patient with asymptomatic high-grade carotid artery stenosis before and after endarterectomy. Contributions to individual vascular territories were quantified using a voxelwise supply fraction algorithm and the results were correlated with MR angiography. RESULTS: Vascular territories were consistent with cerebrovascular anatomy and the presence of pathology. The supply fraction method allowed quantification of mixed territorial supply arising from collateral flow and showed vascular supply changes in a patient with carotid artery stenosis after endarterectomy. CONCLUSIONS: Vascular territories obtained with vessel-encoded arterial spin labeling correlate with cerebrovascular anatomy and allow quantitative assessment of mixed territorial supply in subjects with and without pathology.

Neuroanatomy, neurophysiology, and central auditory assessment. Part I: Brain stem.

This paper is the first in a series of three that address neuroanatomical and neurophysiological aspects of central auditory assessment. The focus of this article is the "auditory" brain stem. Pictures of the auditory structures in the human brain stem in normal and pathological states are shown. Physiological evidence of neural coding of acoustic stimuli is discussed. Relationships between brain stem anatomy/physiology and clinical test results and their interpretation are highlighted.