Ischemic Stroke in Takayasu’s Arteritis: Lesion Patterns and Possible Mechanisms
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose The purpose of the present study was to use brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to identify the mechanism of stroke in patients with Takayasu’s arteritis (TA). Methods Among a retrospective cohort of 190 TA patients, 21 (3 males and 18 females) with a mean age of 39.9 years (range 15-68 years) who had acute cerebral infarctions were included in lesion pattern analyses. The patients’ characteristics were reviewed, and infarction patterns and the degree of cerebral artery stenosis were evaluated. Ischemic lesions were categorized into five subgroups: cortical border-zone, internal border-zone, large lobar, large deep, and small subcortical infarctions. Results In total, 21 ischemic stroke events with relevant ischemic lesions on MRI were observed. The frequencies of the lesion types were as follows: large lobar (n=7, 33.3%), cortical border zone (n=6, 28.6%), internal border zone (n=1, 4.8%), small cortical (n=0, 0%), and large deep (n=7, 33.3%). MRA revealed that 11 patients had intracranial artery stenosis. Conclusions Hemodynamic compromise in large-artery stenosis and thromboembolic mechanisms play significant roles in ischemic stroke associated with TA.
Abstract
Background and Purpose The purpose of the present study was to use brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to identify the mechanism of stroke in patients with Takayasu’s arteritis (TA). Methods Among a retrospective cohort of 190 TA patients, 21 (3 males and 18 females) with a mean age of 39.9 years (range 15-68 years) who had acute cerebral infarctions were included in lesion pattern analyses. The patients’ characteristics were reviewed, and infarction patterns and the degree of cerebral artery stenosis were evaluated. Ischemic lesions were categorized into five subgroups: cortical border-zone, internal border-zone, large lobar, large deep, and small subcortical infarctions. Results In total, 21 ischemic stroke events with relevant ischemic lesions on MRI were observed. The frequencies of the lesion types were as follows: large lobar (n=7, 33.3%), cortical border zone (n=6, 28.6%), internal border zone (n=1, 4.8%), small cortical (n=0, 0%), and large deep (n=7, 33.3%). MRA revealed that 11 patients had intracranial artery stenosis. Conclusions Hemodynamic compromise in large-artery stenosis and thromboembolic mechanisms play significant roles in ischemic stroke associated with TA.
참고문헌 (31)
- Johnston SL, "Takayasu arteritis: a review", J Clin Pathol, 55, pp.481~486 (2002)
- Kim HJ, "Correlation of neurological manifestations of Takayasu’s arteritis with cerebral angiographic findings", Clin Imaging, 29, pp.79~85 (2005)
- Subramanyan R, "Natural history of aortoarteritis (Takayasu’s disease)", Circulation, 80, pp.429~437 (1989)
- Kerr GS, "Takayasu arteritis", Ann Intern Med, 120, pp.919~929 (1994)
- Pfefferkorn T, "Malignant hemispheric infarction in Takayasu arteritis", J Neurol, 255, pp.1425~1426 (2008)
- Ogino H, "Overview of late outcome of medical and surgical treatment for Takayasu arteritis", Circulation, 118, pp.2738~2747 (2008)
- Liang P, "Advances in the medical and surgical treatment of Takayasu arteritis", Curr Opin Rheumatol, 17, pp.16~24 (2005)
- Baird AE, "Multiple acute stroke syndrome: marker of embolic disease?", Neurology, 54, pp.674~678 (2000)
- Lee LJ, "Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography", Stroke, 31, pp.1081~1089 (2000)
- Arend WP, "The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis", Arthritis Rheum, 33, pp.1129~1134 (1990)
- Tatu L, "Arterial territories of human brain: brainstem and cerebellum", Neurology, 47, pp.1125~1135 (1996)
- Amarenco P, "Classification of stroke subtypes", Cerebrovasc Dis, 27, pp.493~501 (2009)
- Chimowitz MI, "The Warfarin-Aspirin Symptomatic Intracranial Disease Study", Neurology, 45, pp.1488~1493 (1995)
- Sikaroodi H, "Stroke as the first manifestation of Takayasu arteritis", Acta Neurol Belg, 107, pp.18~21 (2007)
- Seyahi E, "Atherosclerosis in Takayasu arteritis", Ann Rheum Dis, 65, pp.1202~1207 (2006)
- Marshall J, "The natural history of amaurosis fugax", Brain, 91, pp.419~434 (1968)
- Benavente O, "Prognosis after transient monocular blindness associated with carotid-artery stenosis", N Engl J Med, 345, pp.1084~1090 (2001)
- 이필휴, "Internal and cortical border-zone infarction - Clinical and diffusion-weighted imaging features", STROKE, 37, pp.841~846
- Howard R, "Clinical features of ischemia in cerebral arterial border zones after periods of reduced cerebral blood flow", Arch Neurol, 44, pp.934~940 (1987)
- Spagnoli LG, "Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke", JAMA, 292, pp.1845~1852 (2004)
- Masuda J, "Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases", Neurology, 44, pp.1231~1237 (1994)
- Numano F, "Inflammation and atherosclerosis. Atherosclerotic lesions in Takayasu arteritis", Ann N Y Acad Sci, 902, pp.65~76 (2000)
- Filer A, "Takayasu arteritis and atherosclerosis: illustrating the consequences of endothelial damage", J Rheumatol, 28, pp.2752~2753 (2001)
- Numano F, "Takayasu’s arteritis", Lancet, 356, pp.1023~1025 (2000)
- Molnár P, "Direct involvement of intracerebral arteries in Takayasu’s arteritis", Acta Neuropathol, 63, pp.83~86 (1984)
- Klos K, "Takayasu’s arteritis with arteriographic evidence of intracranial vessel involvement", Neurology, 60, pp.1550~1551 (2003)
- Man BL, "Lesion patterns and stroke mechanisms in concurrent atherosclerosis of intracranial and extracranial vessels", Stroke, 40, pp.3211~3215 (2009)
- Gorelick PB, "Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier", Stroke, 39, pp.2396~2399 (2008)
- Caplan LR, "Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke", Arch Neurol, 55, pp.1475~1482 (1998)
- Caplan LR, "Intracranial large artery occlusive disease", Curr Neurol Neurosci Rep, 8, pp.177~181 (2008)
- Weber R, "Symptomatic intracranial atherosclerotic stenoses: prevalence and prognosis in patients with acute cerebral ischemia", Cerebrovasc Dis, 30, pp.188~193 (2010)