MRI findings of small subcortical "lacunar-like" infarction resulting from large vessel disease

Abstract

Small subcortical infarctions resulting from large-vessel disease are often observed. It is important to distinguish these from pure lacunar infarction resulting from small-vessel disease because the investigations and examinations differ. We investigated the differences on brain magnetic resonance imaging (MRI) between small subcortical "lacunar-like" infarcts resulting from large-vessel disease and pure lacunar infarcts. Thirteen subjects with small lacunar-like infarcts (size < 2 cm), resulting from large-vessel disease, and 30 subjects with lacunar infarcts (< 2 cm), without large-vessel disease were studied. We measured infarction size using a 1.5-T MRI device and evaluated silent subcortical hyperintensity lesions using the modified Scheltens' score. Large-vessel lesion was confirmed by conventional angiography, duplex carotid scan, and magnetic resonance angiography. There was no difference in the mean age of the two groups. Cerebrovascular risk factors and atherosclerotic complications were also comparable for the two groups. Progressive stroke was more common in the lacunar-like infarction group than in the lacunar infarction group (P = 0.004). Scores for periventricular hyperintensity, white matter hyperintensity, basal ganglia hyperintensity, and total subcortical hyperintensity scores were significantly higher in the lacunar infarction group than in the lacunar-like infarction group. The difference in basal ganglia hyperintensity scores was remarkable (P = 0.001). The enlargement of the perivascular space was also significantly greater in the lacunar infarction group than in the lacunar-like infarction group. These findings seem to reflect differences in the pathogenesis of infarction between the two groups. Silent subcortical hyperintensity lesions and enlargement of perivascular space are useful for between distinguishing small lacunar-like infarct resulting from large-vessel disease and pure lacunar infarction. This may have significant implications for the management of patients with lacunar-sized infarctions. It suggests that the pathogenesis of lacunar-sized infarction is variable.

Inverse mismatch and lesion growth in small subcortical ischaemic stroke

“…There have been only a few MRI studies of small subcortical infarcts [14,[16][17][18][19][20][21][22][23][24]. Only smaller than the DWI lesion [21].…”

Diversity of Single Small Subcortical Infarctions According to Infarct Location and Parent Artery Disease

“…Although efforts have been made to distinguish the differences, previous studies have not assessed the relationship between SSSI and PAD 9 -12 or have evaluated limited numbers of patients. 13 We hypothesized that atherosclerosis indicators such as a history of coronary heart disease or the presence of other asymptomatic cerebral arterial atherosclerosis (ACAS) are more prevalent in SSSIϩPAD, whereas leukoaraiosis and microbleeds, surrogate indicators of small vessel disease, 14 -17 are more prevalent in dSSSI-PAD and that pSSSI-PAD may show intermediate features. We also sought to determine whether the prevalence of indicators differs according to vascular territory, that is, the middle cerebral artery (MCA), basilar artery (BA), and vertebral artery (VA).…”

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

“…[1][2][3][4][5] The reported prevalence of silent lesions observed by MRI varies, 3,[6][7][8][9] but there is consensus that it is high in elderly subjects and in patients with risk factors for stroke (eg, hypertension and atrial fibrillation (AF)). 1,4,10,11 The importance of these silent lesions has been emphasized in reports linking them to impaired cognition 2 and depression.…”