Internal Borderzone Infarction in Patients with Ischemic Stroke

Abstract

Objective: The mechanism underlying cerebral infarction in the borderzone between the territories of deep and superficial perforating arteries has not yet been clarified. This study was performed to investigate the prevalence, volume, site, and etiology of this type of subcortical infarction in a large unselected group of stroke patients. Methods and Patients: We analyzed a continuous series of 383 patients with recent cerebral infarction observed in our Stroke Unit. Patients underwent a complete clinical and instrumental workup. The subgroup of subjects with internal borderzone infarct alone were compared with the subgroups of patients with other types of cerebral infarcts by uni- and multivariate statistical tests. Results: There were 90 internal borderzone infarcts of 725 ischemic lesions (12% of the total), with a median volume of 0.32 ml (95% confidence interval 0.24–0.44; range: 0.012–20.2 ml). Internal borderzone infarcts alone occurred in only 13 of 383 (3.4%) patients. A comparison between patients with ‘pure’ internal borderzone infarction and patients with other types of cerebral infarcts by multiple logistic regression analysis demonstrated a significant independent causal role of carotid stenosis or occlusion. Conclusion: Our study suggests that ‘pure’ internal borderzone infarctions are quite rare findings in patients with ischemic stroke, and that the hemodynamic impairment due to atherosclerotic occlusion or stenosis of the carotid system could be the cause in the large majority of cases.

Deep Cerebral Infarcts Extending to the Subinsular Region

“…11 Infarcts in the paraventricular region constitute approximately 3% of infarcts. 6 Infarcts that extend from the paraventricular region to the subinsular region appear to be less frequent, and we have found only a single clinical case description in the literature of a patient with a sensorimotor stroke and dysphasia. 12 Little is known about the pathogenesis and clinical features of these infarcts and whether they differ from infarcts that are localized to the paraventricular region.…”

“…[2][3][4][5][6] The pathogenesis of these paraventricular infarcts appears to be distinct from lacunar infarcts, with hypoperfusion, secondary to largevessel occlusive disease, thought to be the major factor. They are located in the distal ramifications of the lenticulostriate arteries (rather than along the course of the lenticulostriate arteries, as are lacunar infarcts) and frequently are associated with ipsilateral high-grade carotid stenosis and exhausted perfusion reserve.…”

Infarct Patterns in the Middle Cerebral Artery Territory and Their Association with Large Artery Stenosis

“…The relationship between different distribution patterns of cerebral infarcts and the presence of internal carotid artery (ICA) or middle cerebral artery (MCA) stenosis has been studied with inconsistent results [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Classification of cerebral infarcts affecting the cortical territories supplied by the three major cerebral arteries has been largely accepted, although anatomical studies have demonstrated significant variability [18].…”

Non-conventional risk factors were associated with infarct patterns in ischemic stroke

“…Lesion patterns identified on diffusion-weighted imaging (DWI) tend to correlate with the pathogenic mechanism underlying the stroke [1][2][3][4][5][6]. Several studies have shown that topographic patterns on DWI may provide early clues to stroke mechanism, provide prognostic information, and guide therapeutic options in acute ischemic stroke patients [1,3,[7][8][9].…”