title: Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection.
abstract: BACKGROUND
  We prospectively investigated temporal and spatial evolution of intramural hematomas in patients with acute spontaneous internal carotid artery dissection using repeated magnetic resonance imaging over six-months.
  
  
  OBJECTIVE
  The aim of the present study was to assess dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection at multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography.
  
  
  METHODS
  We performed serial multiparametric magnetic resonance imaging in 10 patients with spontaneous internal carotid artery dissection on admission, at days 1, 3, 7-14 and at months 1·5, 3, and 6. We calculated the volume and extension of the hyperintense intramural hematoma using T1w and PD/T2w fat suppressed sequences and assessed the degree of stenosis due to the hematoma using magnetic resonance angiography.
  
  
  RESULTS
  Mean interval from symptom onset to first magnetic resonance imaging was two-days (SD 2·7). Two patients presented with ischemic stroke, three with transient ischemic attacks, and five with pain and local symptoms only. Nine patients had a transient increase of the intramural hematoma volume, mainly up to day 10 after symptom onset. Fifty percent had a transient increase in the degree of the internal carotid artery stenosis on MRA, one resulting in a temporary occlusion. Lesions older than one-week were predominantly characterized by a shift from iso- to hyperintese signal on T2w images. At three-month follow-up, intramural hematoma was no longer detectable in 80% of patients and had completely resolved in all patients after six-months.
  
  
  CONCLUSIONS
  Spatial and temporal dynamics of intramural hematomas after spontaneous internal carotid artery dissection showed an early volume increase with concomitant progression of the internal carotid artery stenosis in 5 of 10 patients. Although spontaneous internal carotid artery dissection overall carries a good prognosis with spontaneous hematoma resorption in all our patients, early follow-up imaging may be considered, especially in case of new clinical symptoms.
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Mila
authors.initials: M
authors.lastname: Nedelcheva
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Xin
authors.initials: X
authors.lastname: Yan
authors.affiliation: University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Slotboom
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Mathier
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Justine
authors.initials: J
authors.lastname: Hulliger
authors.affiliation: University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Verma
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sturzenegger
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.|University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Corrado
authors.initials: C
authors.lastname: Bernasconi
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.affiliation: University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Wiest
authors.affiliation: Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
mesh_terms: D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000473:pathology / Q000503:physiopathology
keywords: MR imaging; acute stroke therapy; arterial dissection; intramural hematoma; neurology; neuroradiology