All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection
A 61-year-old woman arrived at the emergency department of the Hospital Nossa Senhora das Graças, Canoas, southern Brazil, with suspected ischemic stroke. After clinical and laboratory examination, the clinical diagnosis of ischemic stroke was made, without fulfilling criteria for thrombolysis. The...
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| Format: | Article |
| Language: | English |
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Hospital de Clinicas de Porto Alegre ; Universidade Federal do Rio Grande do Sul (UFRGS)
2016-08-01
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| Series: | Clinical and Biomedical Research |
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| Online Access: | http://seer.ufrgs.br/index.php/hcpa/article/view/62735 |
| _version_ | 1828766728941731840 |
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| author | Juliana Avila Duarte Carol Fernandes Jerzewski Sotero da Cunha |
| author_facet | Juliana Avila Duarte Carol Fernandes Jerzewski Sotero da Cunha |
| author_sort | Juliana Avila Duarte |
| collection | DOAJ |
| description | A 61-year-old woman arrived at the emergency department of the Hospital Nossa Senhora das Graças, Canoas, southern Brazil, with suspected ischemic stroke. After clinical and laboratory examination, the clinical diagnosis of ischemic stroke was made, without fulfilling criteria for thrombolysis. The patient had no history of renal failure. Three days later, she performed a magnetic resonance imaging (MRI) examination that confirmed the suspected diagnosis. This examination was performed without sedation or supplemental oxygen. Brain MRI was performed after gadolinium injection, using fluid-attenuated inversion recovery (FLAIR) imaging, T1-weighted image, diffusion-weighted imaging, and T2-weighted image sequences that revealed signs of subacute watershed stroke in the left cerebral hemisphere (Figures 1, 2 and 3). There was a hyperintense cerebrospinal fluid (CSF) in the subarachnoid space (SAS) on FLAIR imaging, a finding that has been reported in many pathologic conditions1 such as superior sagittal thrombosis, subarachnoid hemorrhage², meningitis, meningeal carcinomatosis, next to tumors, status epilepticus and stroke.3-7 It has also been reported in otherwise healthy patients undergoing anesthesia with supplemental oxygen.8 The exact mechanism by which CSF diffuses into the SAS in patients with or without renal insufficiency is not completely explained. Some authores have suggested that in patients with renal failure, the gadolinium may shift across an osmotic gradient at the circumventricular organs in the setting of proctracted elevation of plasma concentrations.9 We believe that the cause of this imaging phenomenon of hyperintense signal of the CSF in the SAS which has already been noted in patients with compromised cerebral perfusion, including cases of acute ischemic stroke, was due to the recent stroke.10-11
Keywords: Flair hyperintensity, MRI, stroke, Gadolinium |
| first_indexed | 2024-12-11T07:13:32Z |
| format | Article |
| id | doaj.art-36bd05b95695423aa4324413d5eb7886 |
| institution | Directory Open Access Journal |
| issn | 0101-5575 2357-9730 |
| language | English |
| last_indexed | 2024-12-11T07:13:32Z |
| publishDate | 2016-08-01 |
| publisher | Hospital de Clinicas de Porto Alegre ; Universidade Federal do Rio Grande do Sul (UFRGS) |
| record_format | Article |
| series | Clinical and Biomedical Research |
| spelling | doaj.art-36bd05b95695423aa4324413d5eb78862022-12-22T01:16:18ZengHospital de Clinicas de Porto Alegre ; Universidade Federal do Rio Grande do Sul (UFRGS)Clinical and Biomedical Research0101-55752357-97302016-08-0136230279All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injectionJuliana Avila Duarte0Carol Fernandes Jerzewski Sotero da Cunha1Serviço de Radiologia, Hospital de Clínicas de Porto Alegre. Porto Alegre, RS.Medica radiologista da Tomoclínica - CanoasA 61-year-old woman arrived at the emergency department of the Hospital Nossa Senhora das Graças, Canoas, southern Brazil, with suspected ischemic stroke. After clinical and laboratory examination, the clinical diagnosis of ischemic stroke was made, without fulfilling criteria for thrombolysis. The patient had no history of renal failure. Three days later, she performed a magnetic resonance imaging (MRI) examination that confirmed the suspected diagnosis. This examination was performed without sedation or supplemental oxygen. Brain MRI was performed after gadolinium injection, using fluid-attenuated inversion recovery (FLAIR) imaging, T1-weighted image, diffusion-weighted imaging, and T2-weighted image sequences that revealed signs of subacute watershed stroke in the left cerebral hemisphere (Figures 1, 2 and 3). There was a hyperintense cerebrospinal fluid (CSF) in the subarachnoid space (SAS) on FLAIR imaging, a finding that has been reported in many pathologic conditions1 such as superior sagittal thrombosis, subarachnoid hemorrhage², meningitis, meningeal carcinomatosis, next to tumors, status epilepticus and stroke.3-7 It has also been reported in otherwise healthy patients undergoing anesthesia with supplemental oxygen.8 The exact mechanism by which CSF diffuses into the SAS in patients with or without renal insufficiency is not completely explained. Some authores have suggested that in patients with renal failure, the gadolinium may shift across an osmotic gradient at the circumventricular organs in the setting of proctracted elevation of plasma concentrations.9 We believe that the cause of this imaging phenomenon of hyperintense signal of the CSF in the SAS which has already been noted in patients with compromised cerebral perfusion, including cases of acute ischemic stroke, was due to the recent stroke.10-11 Keywords: Flair hyperintensity, MRI, stroke, Gadoliniumhttp://seer.ufrgs.br/index.php/hcpa/article/view/62735Flair hyperintensity, MRI, stroke, Gadolinium |
| spellingShingle | Juliana Avila Duarte Carol Fernandes Jerzewski Sotero da Cunha All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection Clinical and Biomedical Research Flair hyperintensity, MRI, stroke, Gadolinium |
| title | All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection |
| title_full | All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection |
| title_fullStr | All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection |
| title_full_unstemmed | All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection |
| title_short | All that glitters is not gold: Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging after gadolinium injection |
| title_sort | all that glitters is not gold increased signal in the subarachnoid space on fluid attenuated inversion recovery imaging after gadolinium injection |
| topic | Flair hyperintensity, MRI, stroke, Gadolinium |
| url | http://seer.ufrgs.br/index.php/hcpa/article/view/62735 |
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