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Correspondence |

Dissection or Hemorrhage Into Arteriosclerotic Plaque—Reply

Yuji Kato, MD, PhD; Tomohisa Dembo, MD, PhD; Hidetaka Takeda, MD, PhD; Akira Uchino, MD, PhD; Ichiro Deguchi, MD; Daisuke Furuya, MD, PhD; Norio Tanahashi, MD, PhD
Arch Neurol. 2011;68(6):830. doi:10.1001/archneurol.2011.116.
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Intramural hematoma with dissection is located within the layers of the tunica media but may be eccentric toward the intima (subintimal dissection) or adventitia (subadventitial dissection). Subintimal dissections are more likely to cause luminal stenosis, whereas subadventitial dissection may cause arterial dilation (aneurysm or fusiform dilation).1

Sylvian vallecula-parallel anatomic scanning (SyPAS) can easily demonstrate the outer contour of the middle cerebral artery without the influence of slow flow, turbulence, or thrombus in the inner lumen.2 Imaging with SyPAS provides additional information about the condition of the middle cerebral artery. The combination of SyPAS imaging and magnetic resonance angiography is especially useful to distinguish dissection with arterial dilation from intraplaque hemorrhage, which has an outer contour seen on SyPAS imaging as smooth and not enlarged. It may be difficult to make a definitive diagnosis in cases of intraplaque hemorrhage with positive remodeling or subintimal dissections without enlarged vascular walls. The epidemiological, clinical, and radiological aspects of both middle cerebral artery dissection and intraplaque hemorrhage are poorly understood.

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June 13, 2011
Yuji Kato, MD, PhD; Tomohisa Dembo, MD, PhD; Hidetaka Takeda, MD, PhD; Akira Uchino, MD, PhD; Ichiro Deguchi, MD; Daisuke Furuya, MD, PhD; Norio Tanahashi, MD, PhD
Arch Neurol. 2011;68(6):830. doi:10.1001/archneurol.2011.116.
June 13, 2011
Damon Fellman, MD
Arch Neurol. 2011;68(6):830. doi:10.1001/archneurol.2011.115.
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