Sulcal effacement with preserved gray-white junction: a sign of reversible ischemia.
OBJECTIVE
Sulcal effacement with preserved underlying gray-white matter junction (isolated sulcal effacement [ISE]) in acute ischemic stroke may not represent irreversible parenchymal injury. We aimed to evaluate the frequency and significance of ISE in patients with large vessel occlusion acute ischemic stroke.


METHODS
Consecutive acute ischemic stroke patients with middle cerebral artery M1 or internal carotid artery terminus occlusions who underwent computed tomography angiogram/perfusion followed by intra-arterial therapy were screened for ISE.


RESULTS
Out of the 568 patients who underwent intra-arterial therapy between March 2011 and September 2014, 108 fulfilled inclusion criteria. ISE was present in 8 (7.4%) patients (age 55.7±10.5 years, 6 female, baseline National Institutes of Health Stroke Scale 16.1±3.8, 5 middle cerebral artery-M1, and 3 internal carotid artery terminus occlusions). Computed tomography angiogram revealed engorged/dilated leptomeningeal vessels obliterating the sulci within the areas of effacement, whereas computed tomography perfusion indicated normal-to-increased cerebral blood volume and prolonged Tmax in all patients. Modified treatment in cerebral ischemia (mTICI) 2b-3 reperfusion was achieved in all patients. Follow-up imaging confirmed no infarct in the ISE area in all patients, and 5 (62%) had modified Rankin Scale 0 to 2 at 3 months.


CONCLUSIONS
Sulcal effacement with preserved gray-white delineation is occasionally visualized in patients with proximal occlusion strokes, relates to robust leptomeningeal collaterals, and indicates preserved underlying parenchyma. ISE should not be used to exclude patients from thrombectomy.
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Diogo C
DC
Haussen
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Andrey
A
Lima
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Michael
M
Frankel
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Aaron
A
Anderson
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Samir
S
Belagaje
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Fadi
F
Nahab
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA.
Srikant
S
Rangaraju
From the Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA. raul.g.nogueira@emory.edu.
Raul G
RG
Nogueira
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D066128:Gray Matter / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D066127:White Matter / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery
brain edema; ischemia; stroke; tomography, computed, scanners