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Glodzik L, Rusinek H, Tsui W, Pirraglia E, Kim HJ, Deshpande A, Li Y, Storey P, Randall C, Chen J, Osorio RS, Butler T, Tanzi E, McQuillan M, Harvey P, Williams SK, Ogedegbe OG, Babb JS, de Leon MJ. Different Relationship Between Systolic Blood Pressure and Cerebral Perfusion in Subjects With and Without Hypertension. Hypertension 2019; 73:197-205. [PMID: 30571554 PMCID: PMC7986962 DOI: 10.1161/hypertensionaha.118.11233] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although there is an increasing agreement that hypertension is associated with cerebrovascular compromise, relationships between blood pressure (BP) and cerebral blood flow are not fully understood. It is not known what BP level, and consequently what therapeutic goal, is optimal for brain perfusion. Moreover, there is limited data on how BP affects hippocampal perfusion, a structure critically involved in memory. We conducted a cross-sectional (n=445) and longitudinal (n=185) study of adults and elderly without dementia or clinically apparent stroke, who underwent clinical examination and brain perfusion assessment (age 69.2±7.5 years, 62% women, 45% hypertensive). Linear models were used to test baseline BP-blood flow relationship and to examine how changes in BP influence changes in perfusion. In the entire group, systolic BP (SBP) was negatively related to cortical (β=-0.13, P=0.005) and hippocampal blood flow (β=-0.12, P=0.01). Notably, this negative relationship was apparent already in subjects without hypertension. Hypertensive subjects showed a quadratic relationship between SBP and hippocampal blood flow (β=-1.55, P=0.03): Perfusion was the highest in subjects with mid-range SBP around 125 mm Hg. Longitudinally, in hypertensive subjects perfusion increased with increased SBP at low baseline SBP but increased with decreased SBP at high baseline SBP. Cortical and hippocampal perfusion decrease with increasing SBP across the entire BP spectrum. However, in hypertension, there seems to be a window of mid-range SBP which maximizes perfusion.
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Affiliation(s)
- Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York,Department of Radiology, NYU School of Medicine, New York,Corresponding author: Lidia Glodzik, Center for Brain Health, Department of Psychiatry, NYU School of Medicine, 145 East 32 Street, New York, NY, 10016. Tel: 212-263-5698, Fax: 212-263-3270;
| | - Henry Rusinek
- Department of Radiology, NYU School of Medicine, New York
| | - Wai Tsui
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Elizabeth Pirraglia
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Hee-Jin Kim
- Department of Neurology, Konkuk University College of Medicine, Seoul, South Korea
| | - Anup Deshpande
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Pippa Storey
- Department of Radiology, NYU School of Medicine, New York
| | - Catherine Randall
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Jingyun Chen
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Ricardo S. Osorio
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Tracy Butler
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Emily Tanzi
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | - Molly McQuillan
- The Eugene Bell Center for Regenerative Biology and Tissue Engineering, Marine Biological Laboratory, Woods Hole, Massachusetts
| | - Patrick Harvey
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
| | | | | | - James S. Babb
- Department of Radiology, NYU School of Medicine, New York
| | - Mony J. de Leon
- Center for Brain Health, Department of Psychiatry, New York University (NYU) School of Medicine, New York
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Förster A, Al-Zghloul M, Eisele P, Wenz H, Böhme J, Groden C, Neumaier-Probst E. Hippocampal infarction: Identification of three new types. J Neuroradiol 2017; 45:1-5. [PMID: 28923531 DOI: 10.1016/j.neurad.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/26/2017] [Accepted: 08/06/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Hippocampal infarction (HI) is common but yet still not comprehensively studied. In the present study, we aimed to identify novel HI patterns and to describe additional ischemic lesions outside the hippocampus to draw conclusions regarding the underlying vessel occlusion. METHODS In 222 patients (mean age 69.9 (±13.6) years; 129 (58.1%) male, 93 (41.9%) female) with HI, diffusion-weighted images were analyzed with emphasis on HI patterns and associated ischemic lesions outside the hippocampus. HI were classified as type 1 (complete), 2 (lateral), 3 (dorsal), and 4 (circumscribed). Further possible HI patterns were defined and classified as type 5 (ventral), 6 (ventrolateral), and 7 (dorsolateral). RESULTS Unilateral HI was found in 218 (98.2%) patients. In these, type 5 and 6 were identified in 5 (2.3%) patients, and type 7 in 8 (3.7%) patients respectively. Type 1 was found in 62 (28.4%), 2 in 53 (24.3%), 3 in 57 (26.1%), and 4 in 28 (12.8%) patients. Further ischemic lesions were found in the territory of the anterior cerebral artery (3.6%), middle cerebral artery (14.9%), anterior choroidal artery (AChA) (7.2%), posterior cerebral artery (89.6%), and in the brainstem (6.3%) and cerebellum (20.3%). Type 5 and 6 were significantly associated with acute ischemic lesions in the AChA territory (6/10 (60%) vs. 11/200 (5.5%), P<0.001). CONCLUSIONS We identified three novel HI types. Probably, type 5 and 6 can be attributed to occlusion of the AChA. Overall, these HI types are rare, possibly due to a better collateralization in the case of AChA occlusion.
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Affiliation(s)
- A Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - M Al-Zghloul
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - P Eisele
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - H Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - J Böhme
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - C Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - E Neumaier-Probst
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Gawlitza M, Böhme J, Maros M, Lobsien D, Michalski D, Groden C, Hoffmann KT, Förster A. FLAIR vascular hyperintensities and 4D MR angiograms for the estimation of collateral blood flow in anterior cerebral artery ischemia. PLoS One 2017; 12:e0172570. [PMID: 28234996 PMCID: PMC5325299 DOI: 10.1371/journal.pone.0172570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess FLAIR vascular hyperintensities (FVH) and dynamic (4D) angiograms derived from perfusion raw data as proposed magnetic resonance (MR) imaging markers of leptomeningeal collateral circulation in patients with ischemia in the territory of the anterior cerebral artery (ACA). METHODS Forty patients from two tertiary care university hospitals were included. Infarct volumes and perfusion deficits were manually measured on DWI images and TTP maps, respectively. FVH and collateral flow on 4D MR angiograms were assessed and graded as previously specified. RESULTS Forty-one hemispheres were affected. Mean DWI lesion volume was 8.2 (± 13.9; range 0-76.9) ml, mean TTP lesion volume was 24.5 (± 17.2, range 0-76.7) ml. FVH were observed in 26/41 (63.4%) hemispheres. Significant correlations were detected between FVH and TTP lesion volume (ρ = 0.4; P<0.01) absolute (ρ = 0.37; P<0.05) and relative mismatch volume (ρ = 0.35; P<0.05). The modified ASITN/SIR score correlated inversely with DWI lesion volume (ρ = -0.58; P<0.01) and positively with relative mismatch (ρ = 0.29; P< 0.05). ANOVA of the ASITN/SIR score revealed significant inter-group differences for DWI (P<0.001) and TTP lesion volumes (P<0.05). No correlation was observed between FVH scores and modified ASITH/SIR scores (ρ = -0.16; P = 0.32). CONCLUSIONS FVH and flow patterns on 4D MR angiograms are markers of perfusion deficits and tissue at risk. As both methods did not show a correlation between each other, they seem to provide complimentary instead of redundant information. Previously shown evidence for the meaning of these specific MR signs in internal carotid and middle cerebral artery stroke seems to be transferrable to ischemic stroke in the ACA territory.
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Affiliation(s)
- Matthias Gawlitza
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
- * E-mail:
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maté Maros
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Förster A, Al-Zghloul M, Wenz H, Böhme J, Groden C, Neumaier-Probst E. Isolated punctuate hippocampal infarction and transient global amnesia are indistinguishable by means of MRI. Int J Stroke 2016; 12:292-296. [PMID: 28112030 DOI: 10.1177/1747493016676613] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Small punctuate lesions in the hippocampus on diffusion-weighted images are a typical finding in transient global amnesia. Consequently, it has been suggested that diffusion-weighted images findings might corroborate the diagnosis of transient global amnesia. However, isolated punctuate hippocampal infarction might be a differential diagnosis of transient global amnesia. Aim Evaluation of isolated punctuate hippocampal infarction frequency and comparison of its clinical presentation and MRI findings to transient global amnesia. Methods From an MRI database, we identified 10 patients with isolated punctuate hippocampal infarction and compared these to 12 patients with transient global amnesia with diffusion-weighted images lesion with regard to clinical symptoms and MRI findings. Results Disorientation and memory deficits were more common in transient global amnesia patients, whereas dysphasia/aphasia and vertigo were more common in hippocampal infarction patients. MRI findings in isolated punctuate hippocampal infarction and transient global amnesia did not differ significantly, neither regarding the affected hemisphere, lesion distribution, size, nor relative ADC values. Conclusions Differentiation of isolated punctuate hippocampal infarction and transient global amnesia based on neuroimaging findings is not possible. Thus, in the case of isolated punctuate hippocampal diffusion-weighted images lesions the final diagnosis of hippocampal infarction or transient global amnesia should be based on the clinical presentation.
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Affiliation(s)
- A Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Al-Zghloul
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - H Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - J Böhme
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - E Neumaier-Probst
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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