title: Effect of dehydration on the development of collaterals in acute middle cerebral artery occlusion.
abstract: OBJECTIVE
  Recent large series studies have demonstrated that dehydration is common amongst stroke subjects and is associated with poor outcome. However, the effects of hydration status on the development of collaterals have never been discussed. In this study, the hypothesis that hydration status is an important factor for developing collaterals after acute middle cerebral artery (MCA) infarction was tested.
  
  
  METHODS
  Eighty-seven patients with acute infarction due to occlusion of the MCA were enrolled. Two collateral markers, posterior cerebral artery (PCA) laterality and fluid-attenuated inversion recovery hyperintense vessels (HVs) were assessed from magnetic resonance imaging. Dehydration status was defined by a nitrogen to creatinine ratio ≧ of 15. The associations between dehydration status and the development of collaterals were estimated.
  
  
  RESULTS
  Sixty-one of 87 patients (70.1%) were identified as dehydrated. The development of PCA laterality and HVs shows a significant difference between dehydrated and euhydrated patients. A serum nitrogen to creatinine ratio <15, diastolic blood pressure and the presence of a dense MCA on computed tomography were significantly associated with the development of PCA laterality. A serum nitrogen to creatinine ratio <15, the initial National Institutes of Health Stroke Scale score, the presence of a dense MCA and calcifications of the internal carotid artery on computed tomography were significantly associated with the development of HVs. Dehydration remained an independent negative predictor for the development of PCA laterality and HVs in the multivariate analysis.
  
  
  CONCLUSIONS
  Hydration status is associated with the development of collateral flow after acute MCA occlusion. This preliminary study provides an imaging clue that hydration status and early hydration therapy could be important for acute stroke management.
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: S-W
authors.initials: SW
authors.lastname: Chang
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: L-C
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: J-T
authors.initials: JT
authors.lastname: Yang
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Weng
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Stroke Center and Department of Neurology, Linkou Medical Center, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
authors.forename: T-H
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation / Q000502:physiology*; D003681:Dehydration / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging; D012042:Registries; D012189:Retrospective Studies
keywords: collateral circulation; dehydration; magnetic resonance angiography; magnetic resonance imaging; stroke