Skip to main content

Novel Imaging Markers of Ischemic Cerebral Edema and Its Association with Neurological Outcome

  • Chapter
Brain Edema XVI

Abstract

Ischemic cerebral edema (ICE) is a recognized cause of secondary neurological deterioration after large hemispheric stroke, but little is known about the scope of its impact. To study edema in less severe stroke, our group has developed several markers of cerebral edema using brain magnetic resonance imaging (MRI). These tools, which are based on categorical and volumetric measurements in serial diffusion-weighted imaging (DWI), are applicable to a wide variety of stroke volumes. Further, these metrics provide distinct volumetric measurements attributable to ICE, infarct growth, and hemorrhagic transformation. We previously reported that ICE independently predicted neurological outcome after adjustment for known risk factors. We found that an ICE volume of 11 mL or greater was associated with worse neurological outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Go AS, Mozaffarian D, Roger VL et al (2014) Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation 129(3):e28–e292

    Article  PubMed  Google Scholar 

  2. Emberson J, Lees KR, Lyden P et al (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384(9958):1929–1935

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Berkhemer OA, Fransen PS, Beumer D et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1):11–20

    Article  PubMed  Google Scholar 

  4. Hacke W, Kaste M, Bluhmki E et al (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329

    Article  CAS  PubMed  Google Scholar 

  5. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) N Engl J Med 333(24):1581–1587

    Google Scholar 

  6. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53(4):309–315

    Article  CAS  PubMed  Google Scholar 

  7. Kimberly WT, Sheth KN (2011) Approach to severe hemispheric stroke. Neurology 76(7 Suppl 2):S50–S56

    Article  PubMed  Google Scholar 

  8. Wijdicks EF, Sheth KN, Carter BS et al (2014) Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke J Cereb Circ 45(4):1222–1238

    Article  Google Scholar 

  9. Vahedi K (2009) Decompressive hemicraniectomy for malignant hemispheric infarction. Curr Treat Options Neurol 11(2):113–119

    Article  PubMed  Google Scholar 

  10. Juttler E, Unterberg A, Woitzik J et al (2014) Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med 370(12):1091–1100

    Article  PubMed  Google Scholar 

  11. Yoo AJ, Sheth KN, Kimberly WT et al (2013) Validating imaging biomarkers of cerebral edema in patients with severe ischemic stroke. J Stroke Cerebrovasc Dis 22(6):742–749

    Article  PubMed Central  PubMed  Google Scholar 

  12. Barber PA, Demchuk AM, Zhang J, Buchan AM (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group Alberta Stroke Programme Early CT Score. Lancet 355(9216):1670–1674

    Article  CAS  PubMed  Google Scholar 

  13. Battey TW, Karki M, Singhal AB et al (2014) Brain edema predicts outcome after nonlacunar ischemic stroke. Stroke 45(12):3643–3648

    Article  PubMed  Google Scholar 

  14. Barrett KM, Ding YH, Wagner DP, Kallmes DF, Johnston KC, Investigators A (2009) Change in diffusion-weighted imaging infarct volume predicts neurologic outcome at 90 days: results of the Acute Stroke Accurate Prediction (ASAP) trial serial imaging substudy. Stroke 40(7):2422–2427

    Article  PubMed Central  PubMed  Google Scholar 

  15. Baird AE, Benfield A, Schlaug G et al (1997) Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 41(5):581–589

    Article  CAS  PubMed  Google Scholar 

  16. Beaulieu C, de Crespigny A, Tong DC, Moseley ME, Albers GW, Marks MP (1999) Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: evolution of lesion volume and correlation with clinical outcome. Ann Neurol 46(4):568–578

    Article  CAS  PubMed  Google Scholar 

  17. Thomalla GJ, Kucinski T, Schoder V et al (2003) Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging. Stroke 34(8):1892–1899

    Article  PubMed  Google Scholar 

  18. Thomalla G, Hartmann F, Juettler E et al (2010) Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study. Ann Neurol 68(4):435–445

    Article  PubMed  Google Scholar 

  19. Todd NV, Picozzi P, Crockard A, Russell RW (1986) Duration of ischemia influences the development and resolution of ischemic brain edema. Stroke 17(3):466–471

    Article  CAS  PubMed  Google Scholar 

  20. Bell BA, Symon L, Branston NM (1985) CBF and time thresholds for the formation of ischemic cerebral edema, and effect of reperfusion in baboons. J Neurosurg 62(1):31–41

    Article  CAS  PubMed  Google Scholar 

  21. Crockard A, Iannotti F, Hunstock AT, Smith RD, Harris RJ, Symon L (1980) Cerebral blood flow and edema following carotid occlusion in the gerbil. Stroke 11(5):494–498

    Article  CAS  PubMed  Google Scholar 

  22. Ayata C, Ropper AH (2002) Ischaemic brain oedema. J Clin Neurosci 9(2):113–124

    Article  PubMed  Google Scholar 

  23. Klatzo I (1967) Presidental address. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol 26(1):1–14

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to W. Taylor Kimberly MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kimberly, W.T. et al. (2016). Novel Imaging Markers of Ischemic Cerebral Edema and Its Association with Neurological Outcome. In: Applegate, R., Chen, G., Feng, H., Zhang, J. (eds) Brain Edema XVI. Acta Neurochirurgica Supplement, vol 121. Springer, Cham. https://doi.org/10.1007/978-3-319-18497-5_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18497-5_40

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18496-8

  • Online ISBN: 978-3-319-18497-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics