Small Infarcts in the Centrum ovale: Study of Predisposing Factors

Abstract

It has recently been suggested that most small (<15 mm) subcortical infarcts (SSI) of the centrum ovale (CO) are of lacunar type. We investigated this hypothesis in 255 consecutive patients with a first-ever ischemic stroke who were examined within 24 h after stroke onset and survived on day 10. Fifty-seven patients had CO-SSI: they were older and more likely to have a silent infarct, a lacunar syndrome, arterial hypertension, leuko-araiosis and SSI localized in the basal ganglia or internal capsule and less likely to have a nonlacunar syndrome. On multiple linear regression analysis, independent factors correlated with CO-SSI were the leuko-araiosis score and the presence of a silent infarct, diabetes mellitus and arterial hypertension. However, the presumed cause of the index stroke was large-vessel disease in 7 patients and heart disease in 16. Though we confirm that patients with CO-SSI are more likely to have risk factors for small-vessel disease, a complete diagnostic workup remains necessary in patients with such infarcts because other mechanisms account for one third of them.

Small Centrum Ovale Infarcts on Diffusion-Weighted Magnetic Resonance Imaging

“…Bogousslavsky and Regli 1 suggested that a symptomatic SCOI was associated with hypertension and diabetes mellitus and with lacunar syndromes but not with occlusive carotid disease and emboligenic heart disease, indicating that it is caused mainly by in situ small-vessel disease involving the white matter medullary artery. Similarly, the other 2 studies 12,13 reported that patients with SCOI were more likely to have risk factors for small-vessel disease. However, there were some problems in these studies.…”

Do Lacunar Infarcts Have Different Aetiologies? Risk Factor Profiles of Lacunar Infarcts in Deep White Matter and Basal Ganglia: The Second Manifestations of ARTerial Disease-Magnetic Resonance Study

“…Our results on lacunar infarcts in the deep white matter are in line with one other longitudinal study, which reported that hypertension was associated with new subcortical lacunar infarcts and that 71% of these lacunar infarcts were surrounded by new WMHs [3] . Cross-sectional studies also reported on an association with hypertension [17,18] . The importance of hypertension is emphasized considering the even higher RR of new lacunes in the deep white matter in patients with untreated hypertension.…”

Frequency and Degree of Carotid Stenosis in Small Centrum Ovale Infarcts as Compared to Lacunar Infarcts

“…There are two previous studies on SCOIs [4,16], In the Lausanne Stroke Registry, 26 out of 2,200 patients (1.2%) had a SCOI [4], whereas in a stroke series from Lille, 57 out of255 patients (22%) had a SCOI. of which, however, only 23 (9%) were symptomatic [16], There are some dif ferences between these two studies and ours, which makes any comparison rather difficult.…”

“…The question arises whether SCOIs are also caused by small-vessel disease, in this case o f the small superficial rather than the deep perforating arteries, or by carotid large-vessel disease with artery-to-artery embolism. Until now, the SCOls have scarcely been stud ied systematically [4,16], although they have been in cluded in other studies [17,18]. Aiming to clarify the pathogenesis of SCOls, we studied the risk factor profile, frequency and severity of carotid stenosis on angiography of patients randomized in the ECST who had a CT defined SCOl as compared with patients with a CT deHned LACI.…”