Vascular morphology, symptoms, diagnostics and treatment of brainstem ischemic stroke

Česká verzia

Authors: D. Ospalík ¹; R. Bartoš ^2,3; V. Němcová ³; Š. Brušáková ¹; D. Černík ¹; F. Cihlář ⁴; A. Hejčl ²; H. Zítek ²; M. Sameš ²
Authors place of work: Neurologické oddělení, Masarykova nemocnice, Krajská zdravotní, a. s., Ústí nad Labem ¹; Neurochirurgická klinika Univerzity J. E. Purkyně, Masarykova nemocnice, Krajská zdravotní, a. s., Ústí nad Labem ²; Anatomický ústav, 1. LF UK, Praha ³; Radiologická klinika Univerzity J. E. Purkyně, Masarykova nemocnice, Krajská zdravotní, a. s., Ústí nad Labem ⁴
Published in the journal: Cesk Slov Neurol N 2020; 83(2): 127-139
Category: Minimonography
doi: https://doi.org/10.14735/amcsnn2020127

Summary

The knowledge of the microanatomy of brain stem perforating arteries can aid in the correct identification of ischemic stroke lesions, explain and provide a proper anatomic description of syndromes associated with the brain stem lesions. The importance of such detailed knowledge is growing when considering the possibilities of acute reperfusion therapy and growing incidence of active treatment of ischemic strokes in posterior circulation. Of course, such knowledge is also vital for neurosurgeons operating in this area. The aim of this work is to present the current knowledge on the anatomy of arteries of the brain stem, brain stem syndromes and present the possibilities of imaging and reperfusion therapy in the vertebrobasilar territory.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

ischemic stroke – vertebrobasilar territory – perforating arteries – brain stem syndromes – reperfusion therapy

Zdroje

1. O’Rahilly R, Müller F. Developmental stages in human embryos: revised and new measurements. Cells Tissues Organs 2010; 192(2): 73– 84. doi: 10.1159/ 000289817.

2. Hill MA. Embryology carnegie stages. [online]. Available from URL: https:/ / embryology.med.unsw.edu.au/ embryology/ index.php/ Carnegie_Stages.

3. ten Donkelaar H, Lammens M, Hori A. Clinical neuroembryology. Berlin, Germany: Springer 2014.

4. Marinković S, de Divitiis O, Nikodijević I. Arteries of the brain and spinal cord: anatomic features and clinical significance. Avellino, Italy: De Angelis 1997.

5. Rhoton A. Cranial anatomy and surgical approaches. Lippincot, USA: Williams & Wilkins 2003.

6. Mehndiratta M, Pandey S, Nayak R et al. Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a north Indian population. Neurohospitalist 2012; 2(2): 46– 50. doi: 10.1177/ 1941874412438902.

7. Adams HP Jr, Bendixen BH, Kappelle LJ et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 1993; 24(1): 35– 41. doi: 10.1161/ 01.STR.24.1.35.

8. Šaňák D, Hutyra M, Král M et al. The twilight of cryptogenic ischaemic stroke – cardio-embolism is the most frequent cause. Cesk Slov Neurol N 2018; 81/ 114(3): 290– 277. doi: 10.14735/ amcsnn2018290.

9. Nouh A, Remke J, Ruland S. Ischemic Posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol 2014; 5: 30. doi: 10.3389/ fneur.2014.00030.

10. Arsava EM, Ballabio E, Benner T et al. The causative classification of stroke system. Neurology 2010; 75(14): 1277– 1284. doi: 10.1212/ WNL.0b013e3181f612ce.

11. Amarenco P, Bogousslavsky J, Caplan LR et al. The ASCOD Phenotyping of ischemic stroke (Updated ASCO Phenotyping). Cerebrovasc Dis 2013; 36(1): 1– 5. doi: 10.1159/ 000352050.

12. Britt TB, Agarwal S. Vertebral artery dissection. In: StatPearls. [online]. Available from URL: https:/ / www.ncbi.nlm.nih.gov/ books/ NBK441827/ .

13. Tsivgoulis G, Katsanos AH, Köhrmann M et al. Embolic strokes of undetermined source: theoretical construct or useful clinical tool? Ther Adv Neurol Disord 2019; 12: 1756286419851381. doi: 10.1177/ 1756286419851381.

14. Yuan YJ, Xu K, Luo Q et al. Research progress on vertebrobasilar dolichoectasia. Int J Med Sci 2014; 11(10): 1039– 1048. doi: 10.7150/ ijms.8566.

15. Katsanos AH, Kosmidou M, Kyritsis AP et al. Is vertebral artery hypoplasia a predisposing factor for posterior circulation cerebral ischemic events? A comprehensive review. Eur Neurol 2013; 70(1– 2): 78– 83. doi: 10.1159/ 000351786.

16. Kaushal V, Schlichter LC. Mechanisms of microglia-mediated neurotoxicity in a new model of the stroke penumbra. J Neurosci 2008; 28(9): 2221– 2230. doi: 10.1523/ JNEUROSCI.5643-07.2008.

17. Tomek A. Neurointenzivní péče. 3. vyd. Praha: Mladá fronta 2018.

18. Manning NW, Campbell BCV, Oxley TJ et al. Acute ischemic stroke: time, penumbra, and reperfusion. Stroke 2014; 45(2): 640– 644. doi: 10.1161/ STROKEAHA.113.003798.

19. Bednařík J, Ambler Z, Růžička E. Klinická neurologie – část speciální I. Praha: Triton 2010: 25– 26.

20. Ambler Z, Bednařík J, Růžička E. Klinická neurologie – část obecná. Praha: Triton 2008: 507– 523.

21. Marx JJ, Thömke F. Classical crossed brain stem syndromes: myth or reality? J Neurol 2009; 256(6): 898– 903. doi: 10.1007/ s00415-009-5037-2.

22. Hurley RA, Flashman LA, Chow TW et al. The brainstem: anatomy, assessment, and clinical syndromes. J Neuropsychiatry Clin Neurosci 2010; 22(1): iv, 1– 7. doi: 10.1176/ jnp.2010.22.1.iv.

23. Duque Parra JE, Llano Idárraga JO, DuqueParra CA. Reflections on eponyms in neuroscience terminology. Anat Rec B New Anat 2006; 289(6): 219– 224. doi: 10. 1002/ ar.b.20121.

24. Harrison TR, Hauser SL, Josephson SA. Harrison’s neurology in clinical medicine. New York, USA: McGraw-Hill Medical 2013.

25. Cuoco J, Hitscherich K, Hoehmann C. Brainstem vascular syndromes: a practical guide for medical students. Edorium J Neurol 2016; 3: 4– 16. doi: 10.5348/ N06-2016-8-RA-2.

26. Arboix A, Bell Y, Garcia-Eroles L et al. Clinical study of 35 patients with dysarthria-clumsy hand syndrome. J Neurol Neurosurg Psychiatry 2004; 75(2): 231– 234.

27. Sakuru R, Bollu PC. Millard-Gubler syndrome. In: StatPearls. [online]. Available from URL: https:/ / www.ncbi.nlm.nih.gov/ books/ NBK532907/ .

29. Vokurka M, Hugo J. Velký lékařský slovník. Praha: Maxdorf 2006: 344.

29. Silverman IE, Liu GT, Volpe NJ et al. The crossed paralyses: the original brain-stem syndromes of Millard-Gubler, Foville, Weber, and Raymond-Cestan. Arch Neurol 1995; 52(6): 635– 638. doi: 10.1001/ archneur.1995.00540300117021.

30. Brainin M, Tabernig S, Heiss WD. Textbook of stroke medicine. Cambridge, UK: Cambridge University Press 2014.

31. Lin MP, Liebeskind DS. Imaging of ischemic stroke. Continuum (Minneap Minn) 2016; 22(5): 1399– 1423. doi: 10.1212/ CON.0000000000000376.

32. Neumann J, Tomek A, Škoda O et al. Doporučený postup pro intravenózní trombolýzu v léčbě akutního mozkového infarktu – verze 2014. Cesk Slov Neurol N 2014; 77/ 110(3): 381– 385.

33. Merwick A, Werring D. Posterior circulation ischaemic stroke. BMJ 2014; 348: g3175. doi: 10.1136/ bmj.g3175.

34. Menon BK, Demchuk AM. Computed tomography angiography in the assessment of patients with stroke/ TIA. Neurohospitalist 2011; 1(4): 187– 199. doi: 10.1177/ 1941874411418523.

35. Pexman JH, Barber PA, Hill MD et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001; 22(8): 1534– 1542.

36. Puetz V, Sylaja PN, Coutts SB et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 2008; 39(9): 2485– 2490. doi: 10.1161/ STROKEAHA.107.511162.

37. Král J, Jonszta T, Marcián V et al. Congruence in evaluating early ischemic changes using the ASPECT score between the neurologist and the interventional neuroradiologist in patients with acute cerebral ischemia. Cesk Slov Neurol N 2018; 81/ 114(3): 304– 307. doi: 10.14735/ amcsnn2018304.

38. Tei H, Uchiyama S, Usui T et al. Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome. J Neurol 2010; 257(5): 767– 773. doi: 10.1007/ s00415-009-5406-x.

39. Šaňák D, Mikulík R, Tomek A et al. Doporučení pro mechanickou trombektomii akutního mozkového infarktu – verze 2019 Cesk Slov Neurol N 2019; 82/ 115(6): 700– 705. doi: 10.14735/ amcsnn2019700.

40. Tomek A. Pacient s rozsáhlými časnými změnami (ASPECT < 5) – rekanalizace – ANO. Cesk Slov Neurol N 2018; 81/ 114(6): 644.

41. Bar M. Pacient s rozsáhlými časnými změnami (ASPECT < 5) – rekanalizace – NE. Cesk Slov Neurol N 2018; 81/ 114(6): 645.

42. Zeleňák K. Pacient s rozsiahlymi skorými zmenami (ASPECTS < 5) – rekanalizácia – komentár ku kontroverziám. Cesk Slov Neurol N 2018; 81/ 114(6): 646.

43. Hwang DY, Silva GS, Furie KL et al. Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct. J Emerg Med 2012; 42(5): 559– 565. doi: 10.1016/ j.jemermed.2011.05.101.

44. Chalela JA, Kidwell CS, Nentwich LM et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007; 369(9558): 293– 298. doi: 10.1016/ S0140-6736(07)60151-2.

45. Macintosh BJ, Graham SJ. Magnetic resonance imaging to visualize stroke and characterize stroke recovery: a review. Front Neurol 2013; 4: 60. doi: 10.3389/ fneur.2013.00060.

46. Schönfeld MH, Ritzel RM, Kemmling A et al. Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI. PLoS One 2018; 13(7): e0200092. doi: 10.1371/ journal.pone.0200092.

47. Halefoglu AM, Yousem DM. Susceptibility weighted imaging: clinical applications and future directions. World J Radiol 2018; 10(4): 30– 45. doi: 10.4329/ wjr.v10.i4.30.

48. Amin-Hanjani S, Du X, Zhao M et al. Use of quantitative magnetic resonance angiography to stratify stroke risk in symptomatic vertebrobasilar disease. Stroke 2005; 36(6): 1140– 1145. doi: 10.1161/ 01.STR.0000166195.63276.7c.

49. Amin-Hanjani S, Pandey DK, Rose-Finnell L et al. Effect of hemodynamics on stroke risk in symptomatic atherosclerotic vertebrobasilar occlusive disease. JAMA Neurol 2016; 73(2): 178– 185. doi: 10.1001/ jamaneurol.2015.3772.

50. Amin-Hanjani S, Du X, Rose-Finnell L et al. Hemodynamic features of symptomatic vertebrobasilar disease. Stroke 2015; 46(7): 1850– 1856. doi: 10.1161/ STROKEAHA.115.009215.

51. Školoudík D. Neurosonologie. Praha: Galén 2003.

52. Rozeman AD, Hund H, Westein M et al. Duplex ultrasonography for the detection of vertebral artery stenosis. Brain Behav 2017; 7(8): e00750. doi: 10.1002/ brb3.750.

53. Bhaskar S, Stanwell P, Cordato D et al. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurology 2018; 18(1): 8. doi: 10.1186/ s12883-017-1007-y.

54. Powers WJ, Rabinstein AA, Ackerson T et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2018; 49(3): e46– e110. doi: 10.1161/ STR.0000000000000158.

55. Dorňák T, Král M, Šaňák D et al. Intravenous thrombolysis in posterior circulation stroke. Front Neurol 2019; 10: 417. doi: 10.3389/ fneur.2019.00417.

56. Sarikaya H, Arnold M, Engelter ST. et al. Outcomes of intravenous thrombolysis in posterior versus anterior circulation stroke. Stroke 2011; 42(9): 2498– 2502. doi: 10.1161/ STROKEAHA.110.607614.

57. Tinková M, Malý P, Parobková H et al. Význam kolaterální cirkulace u akutní okluze arteria basilaris. Cesk Slov Neurol N 2019; 82/ 115(5): 518– 525. doi: 10.14735/ amcsnn2019518.

58. Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P et al. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. J Neurointerv Surg 2019; 11(12): 1174– 1180. doi: 10.1136/ neurintsurg-2018-014516.

59. Šaňák D, Neumann J, Tomek A et al. Doporučení pro rekanalizační léčbu akutního mozkového infarktu – verze 2016. Cesk Slov Neurol N 2016; 79/ 112(2): 231– 234.

60. Turc G, Bhogal P, Fischer U et al. European StrokeOrganisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J NeuroIntervent Surg 2019. pii: neurintsurg-2018-014569. doi: 10.1136/ neurintsurg-2018-014569.

61. Meinel TR, Kaesmacher J, Chaloulos-Iakovidis P et al. Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation. J NeuroIntervent Surg 2019; 11(12): 1174– 1180. doi: 10.1136/ neurintsurg-2018-014516.

62. Baik SH, Park HJ, Kim JH et al. Mechanical thrombectomy in subtypes of basilar artery occlusion: relationship to recanalization rate and clinical outcome. Radiology 2019; 291(3): 730– 737. doi: 10.1148/ radiol.2019181924.

63. Liu X, Dai Q, Ye R et al. BEST Trial Investigators. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 2019; 19(2): 115– 122. doi: 10.1016/ S1474-4422(19)30395-3.

64. Nordmeyer H, Chapot R, Haage P et al. Endovascular treatment of intracranial atherosclerotic stenosis. Fortschr Röntgenstr 2019; 191(7): 643– 652. doi: 10.1055/ a-0855-4298.

65. Chimowitz MI, Lynn MJ, Derdeyn CP et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365(11): 993– 1003. doi: 10.1056/ NEJMoa1105335.

66. Zaidat OO, Fitzsimmons BF, Woodward BK et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA 2015; 313(12): 1240– 1248. doi: 10.1001/ jama.2015. 1693.

67. Nordmeyer H, Chapot R, Aycil A et al. Angioplasty and stenting of intracranial arterial stenosis in perforator-bearing segments: a comparison between the anterior and the posterior circulation. Front Neurol 2018 9: 533. doi: 10.3389/ fneur.2018.00533.

68. Alexander MJ, Zauner A, Chaloupka JC et al. WEAVE Trial Sites and Interventionalists. WEAVE Trial: final results in 152 on-label patients. Stroke 2019; 50(4): 889– 894. doi: 10.1161/ STROKEAHA.118.023996.

69. Ahmed N, Steiner T, Caso V et al. Recommen-dations from the ESO-Karolinska Stroke Update Con-ference, Stockholm 13– 15 November 2016. Eur Stroke J 2017; 2(2): 95– 102. doi: 10.1177/ 2396987317699144.

70. FDA. Food and Drug Administration. FDA safety communication: narrowed indications for use for the Wingspan Stent System.