title: Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection.
abstract: BACKGROUND
  Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail.
  
  
  OBJECTIVE
  To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia.
  
  
  METHODS
  Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease.
  
  
  METHODS
  Large community-based teaching hospital.
  
  
  METHODS
  Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset.
  
  
  METHODS
  Infarct patterns were analyzed according to established templates of vascular territories.
  
  
  RESULTS
  Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6).
  
  
  CONCLUSIONS
  Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.
authors.affiliation: Department of Neurology, Professional Arts Center, University of Miami School of Medicine, Miami, FL 33136, USA. skoch@med.miami.edu
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koch
authors.forename: Murtaza
authors.initials: M
authors.lastname: Amir
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Reyes-Iglesias
authors.forename: Jose G
authors.initials: JG
authors.lastname: Romano
authors.forename: Alejandro
authors.initials: A
authors.lastname: Forteza
mesh_terms: D000328:Adult; D000368:Aged; D001488:Basilar Artery / Q000473:pathology* / Q000503:physiopathology; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002531:Cerebellum / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013788:Thalamus / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D014711:Vertebral Artery / Q000473:pathology* / Q000503:physiopathology; D020217:Vertebral Artery Dissection / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000473:pathology* / Q000503:physiopathology