Journal article
Quantitative Susceptibility Mapping as a Possible Tool to Radiographically Diagnose Sentinel Headache Associated with Intracranial Aneurysm: Case Report
World neurosurgery, Vol.103, pp.954.e1-954.e4
07/2017
DOI: 10.1016/j.wneu.2017.04.151
PMID: 28465264
Abstract
Sentinel headache (SH) occurs before aneurysm rupture in an estimated 15%–60% of cases of aneurysmal subarachnoid hemorrhage (aSAH). By definition, noncontrast computed tomography (CT) scan of the brain and lumbar puncture are both negative in patients presenting with SH. One of the theories explaining this phenomenon is that microhemorrhage (MH) from the aneurysm wall contribute to iron deposition in the interface between the aneurysm wall and brain parenchyma. Quantitative susceptibility mapping (QSM) is a recently introduced magnetic resonance imaging (MRI) technique that has proven capable of localizing the deposition of paramagnetic metals, particularly ferric iron. Thus, the QSM sequence may be able to detect iron deposition secondary to MH.
A 76-year-old male presented with the “worst headache of my life.” Noncontrast head CT scan and lumbar puncture were negative. Magnetic resonance angiography (MRA) of the brain revealed an anterior communicating artery (A-com) aneurysm measuring 7 mm with a large bleb. T1-weighted imaging (WI), T2-WI, MRA, T2 star-weighted angiography (SWAN), and QSM sequences were obtained. T2-WI, SWAN, and QSM revealed isointense, hypointense, and hyperintense signals, respectively, at the interface of the aneurysm wall and brain tissue. These findings were consistent with deposition of ferric iron at this interface. The A-com aneurysm was treated with coil embolization, and the patient exhibited no postoperative deficits.
The MRI QSM sequence can localize iron deposition resulting from MH within an aneurysmal wall. This sequence may be a promising imaging tool for screening patients presenting with SH.
Details
- Title: Subtitle
- Quantitative Susceptibility Mapping as a Possible Tool to Radiographically Diagnose Sentinel Headache Associated with Intracranial Aneurysm: Case Report
- Creators
- Daichi Nakagawa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USACameron Cushing - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAYasunori Nagahama - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USALauren Allan - Department of General Surgery, Mercy Medical Center, Des Moines, Iowa, USADavid Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.103, pp.954.e1-954.e4
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2017.04.151
- PMID
- 28465264
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 07/2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Surgery; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040239502771
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