Middle territory

FIGURE 2.6 Dynamic susceptibility contrast imaging. Axial images of the brain are acquired repeatedly, in this case every 1.5 seconds. As a bolus of intravenously injected contrast material enters the brain, first arteries, then brain parenchyma, and finally veins demonstrate a transient loss of signal intensity. In this acute stroke patient, hypoperfusion of the left middle cerebral artery territory results in delayed arrival of the contrast bolus and prolonged stasis of contrast within the tissue. 

Based primarily on the study protocol of the 1995 NINDS rt-PA study.Many centers would also exclude patients with known documented endocarditis or aortic dissection, and those with CT hypoattenuation in more than one third of the middle cerebral artery territory. There are insufficient data to support the use of rt-PA for ischemic stroke in pregnancy or in the pediatric population (age <18 years). 

Curry Jr, WT, Sethi MK, Ogilvy CS, Carter BS. Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery 2005 56 681-692 [discussion 681-692]. 

Wijdicks EE, Diringer MN. Middle cerebral artery territory infarction and early brain swelling progression and effect of age on outcome. Mayo Clin Proc 1998 73 829-836. 

Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction a systematic review. Stroke 2004 35(2) 539-543. 

Although liver uptake of this compound is relatively high, the ischemic regions of the heart were visualized. SPECT images obtained from cats that were administered BMS-181321 one hour after middle cerebral artery occlusion (MCAO) showed selective brain retention in the ischemic territory of the MCA... 

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Figure 7.39 The Mallik 5L-38 thermal stimulation test. Note the geothermal profile (leftmost line) and reservoir temperature profile (middle fine). (From Hancock, S.H., et al., in Scientific Results from the Mallik 2002 Gas Hydrate Production Research Well Program, Mackenzie Delta, Northwest Territories, Canada, Geological Survey of Canada Bulletin 585, including CD (2005b). With permission.)...

Cerebral blood flow (CBF) was monitored in the cerebral cortex of the ischemic hemisphere corresponding to the supply territory of the middle cerebral artery by laser-doppler flowmetry (DRT4, Moor Instruments, Devon, UK). To this aim, a rectangular bent laser-doppler probe was glued onto the parietal bone (2 mm posterior and 5 mm lateral from bregma) and local CBF was continuously measured from 20 min before the onset of ischemia until 10 min after reperfusion, keeping the animal under isoflurane anaesthesia. Flow values were collected every 5 min before MCAo and after reperfusion whereas data were collected at 10 min intervals during occlusion. 

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