Deep Cerebral Infarcts Extending to the Subinsular Region

Wong, Edward; Pullicino, Patrick; Benedict, Ralph

doi:10.1161/hs1001.096622

Cited by 28 publications

(18 citation statements)

References 27 publications

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“…In those patients more than one vascular risk factor without a large artery atherosclerotic disease was found. As reported previously, artery-to-artery embolism in patients with extracranial large artery stenosis may also give rise to the occlusion of small arteries supplying EcC-ExC area [25, 26]. In 3 of our patients there was prominent carotid artery disease which could cause temporary occlusion of the distal branches of the middle cerebral artery by small distal emboli.…”

Section: Discussionsupporting

confidence: 65%

External and Extreme Capsular Stroke: Clinical, Topographical and Etiological Patterns

Kumral

Çallı²

2006

Cerebrovasc Dis

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Background and Purpose: To characterize clinically acute external (EcC) and extreme capsular (ExC) strokes in 9 patients with first-ever acute stroke. Methods: Nine patients with a lesion limited to the EcC-ExC region proven by diffusion-weighted imaging included in our registry, corresponding to 0.3% of 3,600 patients with ischemic stroke, were studied. Results: We found three main groups of clinical manifestations: (1) motor deficits in all patients (4 with faciobrachial, 2 with faciobrachiocrural, and 1 with brachiocrural, crural and facial paresis each); (2) hypesthesia in 3 patients with partial distribution concerning light touching without involvement of other sensory modalities; (3) transient speech disturbance at stroke onset in 1 patient and dysarthria in 2 patients. Small artery disease in 4 patients and artery-to-artery embolism in 3 patients probably from atherosclerotic carotid artery were the main stroke mechanism. Conclusions: Strokes restricted to the EcC-ExC region may present with complete or partial motor syndromes and dysarthria as prominent clinical presentations, but also fou rire prodromique and transient speech arrest as prodromal signs. The main etiology of stroke were microangiopathy and artery-to-artery embolism, even though no obvious cause was found in 1 patient. The prognosis was good in almost all patients.

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Section: Discussionsupporting

confidence: 65%

External and Extreme Capsular Stroke: Clinical, Topographical and Etiological Patterns

Kumral

Çallı²

2006

Cerebrovasc Dis

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“…Larger infarction volume of pLSAIs with MCA disease may reflect that more perforators are involved in patients with more severe MCA disease. Poor collateral flow in patients with MCA disease or carotid disease was suggested as a possible mechanism of large deep cerebral infarcts [15]. In this study, larger infarcts in patients with MCA disease may be a consequence of low flow infarcts with insufficient collateral flow.…”

Section: Discussionmentioning

confidence: 68%

“…Infarctions involving the vascular territory of the LSA, such as classic lacunar infarctions in the basal ganglia [3,4], lacunar or striatocapsular infarctions with middle cerebral artery (MCA) disease [5,6,7,8], embolism [9,10] or deep subcortical infarctions [11,12,13,14,15], have been studied in diverse ways. Lacunar infarcts with pial or border-zone infarcts are a probable lesion pattern for LSA territorial infarctions with MCA disease [7,14].…”

Section: Introductionmentioning

confidence: 99%

Perforator Territory Infarction in the Lenticulostriate Arterial Territory: Mechanisms and Lesion Patterns Based on the Axial Location

Cho¹,

Roh²,

Moon³

et al. 2010

Eur Neurol

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Background: We hypothesized that perforator territory infarcts in the lenticulostriate territory (pLSAIs) may have heterogeneous lesion patterns and stroke mechanisms. Methods: We reviewed prospectively collected patients who developed pLSAIs within 72 h after stroke onset. Lesion patterns were analyzed based on the six axial levels. Based on MR angiography, stenosis of the middle cerebral artery (MCA) was classified into 3 groups. White matter hyperintensities were assessed by Fazeka’s scale of periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). Results: Of 221 patients, 159 were normal, 44 had mild stenosis, and 18 had severe stenosis of the MCA. Larger infarct volume was correlated with the severity of MCA disease (r = 0.289, p < 0.001). Lower lesion patterns were correlated with the severity of MCA disease (r = –0.294, p < 0.001). A higher lesion pattern was correlated with the severity of DWMH or PVH scores (r = 0.205, p = 0.002 in DWMH, and r = 0.137, p = 0.042 in PVH). Conclusions: Patients with MCA disease have larger and lower lesion patterns beginning from the proximal territory of the lenticulostriate artery (LSA). Patients with severe white matter changes have smaller and higher lesion patterns in the distal territory of the LSA.

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“…Regarding anatomoclinical correlation, the most important factor was lesion size rather than infarct location, especially in the anterior circulation territory, even though some critical areas [20]could be crucial, such as: thalamus [21], internal capsule [22], superior segment of the corona radiata [23], subinsular region [24]and other subcortical gray matter sites [25]. Of our dysphagic patients with small subcortical lesions, in addition to the involvement of the above critical areas, 7 patients had multiple bilateral lacunes.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia following Stroke

et al. 2004

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Background: Dysphagia is common after stroke. We aimed to study the prognosis of dysphagia (assessed clinically) over the first 3 months after acute stroke and to determine whether specific neurovascular-anatomical sites were associated with swallowing dysfunction. Methods: We prospectively examined consecutive patients with acute first-ever stroke. The assessment of dysphagia was made using standardized clinical methods. The arterial territories involved were determined on CT/MRI. All patients were followed up for 3 months. Results: 34.7% of 406 patients had dysphagia. Dysphagia was more frequent in patients with hemorrhagic stroke (31/63 vs. 110/343; p = 0.01). In patients with ischemic stroke, the involvement of the arterial territory of the total middle cerebral artery was more frequently associated with dysphagia (28.2 vs. 2.2%; p < 0.0001). Multivariate analysis revealed that stroke mortality and disability were independently associated with dysphagia (p < 0.0001). Conclusions: The frequency of dysphagia was relatively high. Regarding anatomical-clinical correlation, the most important factor was the size rather than the location of the lesion. Dysphagia assessed clinically was a significant variable predicting death and disability at 90 days.

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Deep Cerebral Infarcts Extending to the Subinsular Region

Cited by 28 publications

References 27 publications

External and Extreme Capsular Stroke: Clinical, Topographical and Etiological Patterns

External and Extreme Capsular Stroke: Clinical, Topographical and Etiological Patterns

Perforator Territory Infarction in the Lenticulostriate Arterial Territory: Mechanisms and Lesion Patterns Based on the Axial Location

Dysphagia following Stroke

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