The Neuroradiology Journal 20: 265-270, 2007
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Middle Cerebral Artery Occlusion Causing Intracerebral Hemorrhage: Radiologic Findings M. UENO, A. UCHINO, R. EGASHIRA, K. NOMIYAMA, Y. TAKASE, S. KUDO Department of Radiology, Saga Medical School; Nabeshima, Saga, Japan
Key words: middle cerebral artery occlusion, intracerebral hemorrhage, CT, MRI, angiography
SUMMARY – Middle cerebral artery (MCA) occlusion usually leads to cerebral infarction but rarely causes cerebral hemorrhage without infarction. We retrospectively investigated the unique radiographic manifestations in cases of cerebral hemorrhage without infarction. Computed tomography (CT) and angiographic images obtained in four patients (aged 26 to 70 years) with MCA occlusion associated with intracerebral hemorrhage were reviewed. Two patients also underwent magnetic resonance imaging (MRI), and one of these underwent magnetic resonance angiography as well; these images were also examined. Cranial CT revealed periventricular hemorrhage with ventricular penetration in one patient and with putaminal penetration in two. Solitary ventricular hemorrhage was found in the fourth patient. Angiography showed ipsilateral occlusion at the M1 portion of the MCA, accompanied by moyamoya-like vessels. No aneurysm or arteriovenous malformation was detected. MRI showed absence of the flow void in the affected MCA and an abnormal flow void in dilated collateral vessels in the basal ganglia. MCA occlusion can cause periventricular or ventricular hemorrhage, which appears to result from bleeding from fragile dilated collateral vessels and, thus, to have an etiology similar to that of adult moyamoya disease. MRI shows promise as a tool for evaluating the occlusion site.
Introduction Middle cerebral artery (MCA) occlusion is usually caused by thromboembolism or atherosclerosis. Infarction is a frequent radiologic manifestation in cases of MCA occlusion.However, cerebral hemorrhage without infarction has been observed in a few cases of MCA occlusion. To our knowledge, there are few reports describing the radiologic features of MCA occlusion causing intracranial hemorrhage1-4. Thus, we present the unique radiologic characteristics of MCA occlusion causing intracerebral hemorrhage. Materials and Methods Cases included in the study were the four cases of angiographically proven MCA occlusion we encountered over the past 22 years.
Two of the four patients had a history of hypertension. Cranial computed tomography (CT) without contrast media was performed immediately after admission in all cases. Magnetic resonance imaging (MRI) was performed in two cases, and magnetic resonance angiography (MRA) was performed in one of these cases as well. The interval between onset of clinical symptoms and MRI examination varied from five days to one month. MRI was performed with a 1.5-T system. T1-weighted images were obtained with TR/ TE=400/20 and T2-weighted images with TR/ TE=2000/80. Three-dimensional time-of-flight MRA was performed. Bilateral internal carotid and unilateral vertebral angiography via transfemoral approach were also performed in all cases. 265
Middle Cerebral Artery Occlusion Causing Intracerebral Hemorrhage: Radiologic Findings
M. Ueno
Results Table 1 Data of our cases
Angiographic Findings
Age/sex/side/ past history
Location of hemorrhage on CT
1
44/M/L/none
Putamen, Ventricular hemorrhage
Putaminal hemorrhage, Absence of flow void of left MCA Collateral vessels in the basal ganglia, Left MCA (M1) occlusion (MRA)
Left MCA occlusion at its origin, Moyamoya type vessels, Dilatation of anterior choroidal artery
2
70/F/R/hypertension, subarachnoid hemorrhage
Putamen, Ventricular hemorrhage
Not performed
Right MCA occlusion at its proximal portion, Moyamoya type vessels
3
46/M/R/hypertension
Periventricular region, Ventricular penetration
Periventricular hemorrhage, Absence of flow void of right MCA
Right MCA occlusion at its origin, Moyamoya type vessels, Dilatation of right ACA
4
26/F/(R
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Middle Cerebral Artery Occlusion Causing Intracerebral Hemorrhage: Radiologic Findings M. UENO, A. UCHINO, R. EGASHIRA, K. NOMIYAMA, Y. TAKASE, S. KUDO Department of Radiology, Saga Medical School; Nabeshima, Saga, Japan
Key words: middle cerebral artery occlusion, intracerebral hemorrhage, CT, MRI, angiography
SUMMARY – Middle cerebral artery (MCA) occlusion usually leads to cerebral infarction but rarely causes cerebral hemorrhage without infarction. We retrospectively investigated the unique radiographic manifestations in cases of cerebral hemorrhage without infarction. Computed tomography (CT) and angiographic images obtained in four patients (aged 26 to 70 years) with MCA occlusion associated with intracerebral hemorrhage were reviewed. Two patients also underwent magnetic resonance imaging (MRI), and one of these underwent magnetic resonance angiography as well; these images were also examined. Cranial CT revealed periventricular hemorrhage with ventricular penetration in one patient and with putaminal penetration in two. Solitary ventricular hemorrhage was found in the fourth patient. Angiography showed ipsilateral occlusion at the M1 portion of the MCA, accompanied by moyamoya-like vessels. No aneurysm or arteriovenous malformation was detected. MRI showed absence of the flow void in the affected MCA and an abnormal flow void in dilated collateral vessels in the basal ganglia. MCA occlusion can cause periventricular or ventricular hemorrhage, which appears to result from bleeding from fragile dilated collateral vessels and, thus, to have an etiology similar to that of adult moyamoya disease. MRI shows promise as a tool for evaluating the occlusion site.
Introduction Middle cerebral artery (MCA) occlusion is usually caused by thromboembolism or atherosclerosis. Infarction is a frequent radiologic manifestation in cases of MCA occlusion.However, cerebral hemorrhage without infarction has been observed in a few cases of MCA occlusion. To our knowledge, there are few reports describing the radiologic features of MCA occlusion causing intracranial hemorrhage1-4. Thus, we present the unique radiologic characteristics of MCA occlusion causing intracerebral hemorrhage. Materials and Methods Cases included in the study were the four cases of angiographically proven MCA occlusion we encountered over the past 22 years.
Two of the four patients had a history of hypertension. Cranial computed tomography (CT) without contrast media was performed immediately after admission in all cases. Magnetic resonance imaging (MRI) was performed in two cases, and magnetic resonance angiography (MRA) was performed in one of these cases as well. The interval between onset of clinical symptoms and MRI examination varied from five days to one month. MRI was performed with a 1.5-T system. T1-weighted images were obtained with TR/ TE=400/20 and T2-weighted images with TR/ TE=2000/80. Three-dimensional time-of-flight MRA was performed. Bilateral internal carotid and unilateral vertebral angiography via transfemoral approach were also performed in all cases. 265
Middle Cerebral Artery Occlusion Causing Intracerebral Hemorrhage: Radiologic Findings
M. Ueno
Results Table 1 Data of our cases
Angiographic Findings
Age/sex/side/ past history
Location of hemorrhage on CT
1
44/M/L/none
Putamen, Ventricular hemorrhage
Putaminal hemorrhage, Absence of flow void of left MCA Collateral vessels in the basal ganglia, Left MCA (M1) occlusion (MRA)
Left MCA occlusion at its origin, Moyamoya type vessels, Dilatation of anterior choroidal artery
2
70/F/R/hypertension, subarachnoid hemorrhage
Putamen, Ventricular hemorrhage
Not performed
Right MCA occlusion at its proximal portion, Moyamoya type vessels
3
46/M/R/hypertension
Periventricular region, Ventricular penetration
Periventricular hemorrhage, Absence of flow void of right MCA
Right MCA occlusion at its origin, Moyamoya type vessels, Dilatation of right ACA
4
26/F/(R
