Acute Caudate Vascular Lesions

Abstract

Background and Purpose-We sought to evaluate demographic features, risk factors, clinical profiles, and behavioral abnormalities in patients with caudate lesion, either with infarct or with hemorrhage involving the caudate nucleus. Methods-We studied all patients with acute caudate stroke confirmed by CT or MRI who were admitted to our stroke unit over a 5-year period. A database containing risk factors, clinical features, type and mechanism of stroke, and caudate vascular territories was analyzed. Results-Thirty-one patients had acute caudate stroke (24 men and 7 women; mean age, 62.3 years). Caudate infarct was present in 25 patients and caudate hemorrhage in 6. The main risk factors for caudate infarct were hypertension (64%), hypercholesterolemia (32%), diabetes mellitus (28%), and previous myocardial infarct (20%). Hypertension was present in 4 patients (67%) with caudate hemorrhage, and arteriovenous malformation was present in 1 patient (17%). Small-artery disease was diagnosed in 14 patients (59%), cardiac embolism in 5 patients (20%), and large-artery disease in 2 patients (8%), and 2 patients (8%) had mixed etiology. The most frequent neurological abnormalities were abulia and psychic akinesia (48%), frontal system abnormalities (26%), speech deficits in patients with left-sided lesions (23%), and neglect syndromes in those with right-sided lesions (10%). Fifteen patients with caudate infarct (60%) and 3 patients with hemorrhage (50%) were able to return to normal daily life. Patients with infarct in the territory of the lateral lenticulostriate arteries extending to neighboring structures showed more frequent motor and neuropsychological deficits than those with infarct in the territory of the anterior lenticulostriate arteries. Conclusions-The clinical presentation of patients with caudate hemorrhage mimicked subarachnoid hemorrhage with or without motor and neuropsychological signs. Caudate vascular lesions with concomitant neighboring structure involvement represent a specific stroke syndrome, usually caused by small-artery disease and in one fifth of the patients caused by cardiac embolism. The behavioral abnormalities were mostly due to medial, lateral, and ventral caudate subnuclei damage and coexisting lesion of the anterior limb of the internal capsule. (Stroke. 1999;30:100-108.)

Change in artistic expression related to subthalamic stimulation

“…Contrasts were used to test for differences between the levels of the factor stimulation. The results of the line bisection task were analyzed by a 4 ϫ 3 factor design using the variables stimulation (right OFF/left OFF, right ON/left OFF, right OFF/left ON, and right ON/left ON) and length of the line (8,16, and 24 cm). Again, contrasts were used to test for differences between the levels of the factors.…”

“…3,6 -10 Various studies have documented that lesions restricted to the right basal ganglia lead to an asymmetry in space exploration and a failure to react or respond to stimuli located in the contralateral hemispace. 2,[11][12][13][14][15][16][17][18] Most of these studies examine patients with neglect as a consequence of stroke and it has been controversial if hemispatial neglect following subcortical lesions are the consequence of associated cortical dysfunction not visible by structural computer tomography or conventional magnetic resonance imaging (MRI). 15,19,20 In support of this hypothesis, several studies have shown cortical hypoperfusion in patients with neglect associated with subcortical stroke using MR perfusion-weighted imaging or single photon emission computed tomography (SPECT).…”

Comment on the brain areas whose blood supply is provided by the recurrent artery of Heubner

“…Ãzci et al reported that this artery supplies blood to important areas, such as the medial portion of orbitofrontal area, head of the caudate nucleus, anterior portion of putamen, external segment of globus pallidus, and anterior limb of the internal capsule [2]. We would just like to add another very important brain area where this important artery also supplies blood and which is the nucleus accumbens [1,3]. This nucleus is a major component of the ventral striatum and speciWcally the area of continuity between the head of the caudate nucleus and the putamen [5].…”

Analysis of Correlation between the Number of Lenticulostriate Arteries and Hypertension Based on High-Resolution MR Angiography Findings

“…[1][2][3] Hypertension can alter the vascular structure, mechanics, and function of small arteries and arterioles. 4,5 These changes disturb the structure and function of microcirculation, resulting in increased vascular resistance and reduced blood flow through the microvessels.…”