An unusual cause of ischemic stroke — the presence of structural bone and cartilage anomalies which cause mechanical stress to arteries supplying the brain — has been highlighted in a new case series.
These so-called “bony strokes” constitute a possible cause of recurrent ischemia in the same vascular territory as previous episodes, note the authors, led by Johanna Haertl, MD, Technical University of Munich, School of Medicine, Munich, Germany.
“In patients with recurrent strokes in one vascular territory the presence of a symptomatic anatomic bone or cartilage anomaly may be considered as a differential diagnosis after sufficient exclusion of competing etiologies of an ischemic stroke,” they conclude.
“Due to the possibly high risk of stroke recurrence and potentially causative treatment options, bony strokes seem to be highly relevant for clinical practice,” they add.
The study was published online April 13 in the journal Stroke.
In their report, investigators explain that diagnosis of a bony stroke is based on a combination of imaging devices including CT, MRI, angiography, and sonography of brain supplying vessels.
In addition to conventional static imaging, dynamic imaging modalities with the patients’ head in a fixed rotation or reclination has been shown to be useful as this enables the detection of a compressive effect on brain supplying arteries caused by head movement.
They note that these bony strokes have been described previously — mainly as single case reports or small case series — but a systematic evaluation of each anatomical type of bony stroke is currently lacking.
For the current paper, the authors describe the identification and therapeutic workup of six patients with a bony stroke among 4200 patients with ischemic stroke treated from January 2017 to March 2022 at their comprehensive stroke care center, constituting an incidence of 0.14%.
But they caution, “Given our retrospective study design, the method of patient acquisition, and the lack of systematic evaluation of bony strokes during acute stroke treatment, epidemiologic conclusions can be drawn only very carefully.”
In each of these six cases, the recurrent stroke was found to be caused by large artery embolism from mechanical stress by bone or cartilage anomalies on arteries supplying the brain.
An unusual cause of ischemic stroke — the presence of structural bone and cartilage anomalies which cause mechanical stress to arteries supplying the brain — has been highlighted in a new case series.
These so-called “bony strokes” constitute a possible cause of recurrent ischemia in the same vascular territory as previous episodes, note the authors, led by Johanna Haertl, MD, Technical University of Munich, School of Medicine, Munich, Germany.
“In patients with recurrent strokes in one vascular territory the presence of a symptomatic anatomic bone or cartilage anomaly may be considered as a differential diagnosis after sufficient exclusion of competing etiologies of an ischemic stroke,” they conclude.
“Due to the possibly high risk of stroke recurrence and potentially causative treatment options, bony strokes seem to be highly relevant for clinical practice,” they add.
The study was published online April 13 in the journal Stroke.
In their report, investigators explain that diagnosis of a bony stroke is based on a combination of imaging devices including CT, MRI, angiography, and sonography of brain supplying vessels.
In addition to conventional static imaging, dynamic imaging modalities with the patients’ head in a fixed rotation or reclination has been shown to be useful as this enables the detection of a compressive effect on brain supplying arteries caused by head movement.
They note that these bony strokes have been described previously — mainly as single case reports or small case series — but a systematic evaluation of each anatomical type of bony stroke is currently lacking.
For the current paper, the authors describe the identification and therapeutic workup of six patients with a bony stroke among 4200 patients with ischemic stroke treated from January 2017 to March 2022 at their comprehensive stroke care center, constituting an incidence of 0.14%.
But they caution, “Given our retrospective study design, the method of patient acquisition, and the lack of systematic evaluation of bony strokes during acute stroke treatment, epidemiologic conclusions can be drawn only very carefully.”
In each of these six cases, the recurrent stroke was found to be caused by large artery embolism from mechanical stress by bone or cartilage anomalies on arteries supplying the brain.
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