Cerebral Misery Perfusion on Susceptibility Weighted Imaging in Acute Carotid Dissection

Authors

  • Arian Mashhood
  • Geoffrey McWilliams
  • Paggie Kim
  • Frankis Almaguel
  • J. Paul Jacobson

DOI:

https://doi.org/10.3941/jrcr.v10i10.2653

Keywords:

cerebral misery perfusion, susceptibility-weighted imaging, susceptibility weighted imaging, SWI, carotid artery dissection, vertebral artery dissection, cerebral autoregulation, hemodynamic failure, neurointerventional radiology, stroke intervention

Abstract

The cerebral vasculature incorporates several fail-safes that must be breached before an irreversible ischemic event takes place. In particular, when autoregulatory vasodilatation fails secondary to falling cerebral perfusion pressure (CPP; stage I hemodynamic failure), increases in the oxygen extraction fraction work to maintain the cerebral metabolic rate of oxygen. Previously, failure of this mechanism, stage II hemodynamic failure, or misery perfusion, has been imaged via positron emission tomography/computed tomography (PET/CT). Current susceptibility-weighted sequences (SWI) allow for more efficient imaging of this physiology. In this case, we identify an incident of reversible ischemia caused by spontaneous carotid artery dissection using a combination of diffusion weighted imaging (DWI) and SWI. The level of hemodynamic failure identified by the imaging sequences elevated the urgency of neurointervention, expediting the patient's arrival to the neurointerventional table and thus avoiding impending irreversible ischemia.

Author Biographies

Arian Mashhood

Resident Physician, Department of Radiology

Loma Linda University Medical Center

Geoffrey McWilliams

Medical Student

Loma Linda University School of Medicine

Paggie Kim

Physician Fellow, Department of Radiology

Loma Linda University Medical Center

Frankis Almaguel

Resident Physician, Department of Radiology

Loma Linda University Medical Center

J. Paul Jacobson

Assistant Professor, Radiology and Neurosurgery

Director, Neuroradiology

Program Director, Diagnostic and Neuroradiology

Loma Linda University Medical Center

Journal of Radiology Case Reports October 2016 issue - Cover page: Percutaneous Cholecystostomy and Hydrodissection in Radiofrequency Ablation of Liver Subcapsular Leiomyosarcoma Metastasis Adjacent to the Gallbladder: Protective Effect. by André Azevedo.

Downloads

Published

2016-10-23

Issue

Vol. 10 No. 10 (2016)

Section

Neuroradiology

License

The publisher holds the copyright to the published articles and contents. However, the articles in this journal are open-access articles distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License, which permits reproduction and distribution, provided the original work is properly cited. The publisher and author have the right to use the text, images and other multimedia contents from the submitted work for further usage in affiliated programs. Commercial use and derivative works are not permitted, unless explicitly allowed by the publisher.