Infarct subcortical

Singer MB, Chong J, Lu D, Schonewille WJ, Tuhrim S, Atlas SW. Diffusion-weighted MRI in acute subcortical infarction. Stroke 1998 29 133-136. 

Unlu M et al. Detection of complement factor B in the cerebrospinal fluid of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy disease using two-dimensional gel electrophoresis and mass spectrometry. Neurosci Lett 2000 282 149-152. 

Frontal and subcortical lacunar infarcts typically affect attention, language, visuospatial function, and motor programming (Babikian et al. 1990). Compared to patients with Alzheimer s disease, those with vascular dementia show better orientation, recall, and language ability. On... 

Missense mutations in the Notch3 gene cause CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and lenkoencephalopathy). Notch is a type I integral membrane protein proteolytically processed in its extracellular domain by fnrin and the metalloproteinase knzbanian. The signal transduction cascade... 

Hossmann KA (1999) The hypoxic brain. Insights from ischemia research. Adv Exp Med Biol 474 155-169 Karnath HO, Himmelbach M, Rorden C (2002) The subcortical anatomy of human spatial neglect putamen, caudate nucleus and pulvinar. Brain 125 350-360 Kataoka S, Hori A, Shirakawa T et al (1997) Paramedian pontine infarction. Neurological/topographical correlation. Stroke 28 809-815... 

Many individuals with LA also harbor lacunar and/or cortical infarcts. Presence of LA serves as an intermediate surrogate both for ischemic stroke and intracerebral hemorrhage as they all share similar risk factors and similar pathophysiological mechanisms (Inzitari 2003). LA is widely found in dementing illnesses, such as Alzheimer s disease, vascular dementia, and cerebral autosomal dominant arteri-opathy with subcortical infarcts and leukoencepha-lopathy (CADASIL). Failure of blood supply in the... 

DWI promises to have tremendous value in accurately localizing the subcortical or brainstem lesion(s). A summary of studies of DWI in patients with lacunar stroke is provided in Table 13.2. It is noteworthy that there is also a group of patients with lacunar infarction who harbor multiple chronic white matter lesions on the conventional MRI and present with non-specific syndromes that could not be attributed to a specific arterial territory. Such symptoms include worsening of a preexisting dysarthria, dysphagia or ataxia, sudden appearance of emotional incontinence or recent onset bowel or bladder problems. Excellent diagnostic performance of DWI in lacunar infarctions may help to prove ischemia as the cause of non-specific neurological symptoms in such patients. 

Singer et al. (1998) 39 Clinical diagnosis of acute subcortical infarction DWI has accuracy of 94.6% for acute subcortical infarction and differentiates acute from non-acute lesions... 

Bamford J (2001) Classical lacunar syndromes. In Bogousslavsky J, Caplan L (eds) Sreoke syndromes. Cambridge University Press, Cambridge, pp 583-589 Bamford J, Bogousslavsky J (eds) (2002) Subcortical stroke, 2nd edn. Oxford Medical Publications, Oxford, pp 27-34 Bamford J, Sandercock P, Jones L, Warlow C (1987) The natural history of lacunar infarction the Oxfordshire Community Stroke Project. Stroke 18 545-551 Benito-Leon J, Alvarez-Linera J, Porta-Etessam J (2001 Detec-tion of acute pontine infarction by diffusion-weighted MRI in capsular warning syndrome. Cerebrovasc Dis 11 350-351... 

Van den Boom R, Lesnik Oberstein SA, van Duinen SG, Bor-nebroek M, Ferrari MD, Haan J, van Buchem MA (2002) Subcortical lacunar lesions an MR imaging finding in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Radiology 224 791-796... 

MCA infarcts are mainly caused by cardioembolism, internal carotid artery (ICA) thrombosis, dissection or embolism and rarely (in Caucasians) by intrinsic MCA disease. MCA atherothrombotic territory infarctions related to intrinsic MCA disease often cause concomitant small cortical (territorial or borderzone) and subcortical infarcts (Min et al. 2000). 

MCA stenosis causes subcortical stroke either by occlusion of a single penetrating artery to produce a small lacunar infarct or by artery to artery embolism with impaired clearance of emboli that produces multiple small cerebral infarcts, mainly in borderzone regions (Wong et al. 2002). 

Subcortical white matter infarcts may mimic a superficial MCA infarct causing a partial anterior circulation syndrome or present as a lacunar syndrome (pure motor, ataxic hemiparesis or sensori motor stroke). Superficial perforating artery infarcts (medullary branches) are often accompanied by cortical spotty lesions. Borderzone and white matter medullary branches infarctions are usually caused by hypoperfusion due lo large vessel occlusion or stenosis (Bogousslavsky 1993 Donnan and Yasaka 1998), but white matter medullary branches infarction can also be caused by cardioembolism (Lee et al. 2003). 

Bogousslavsky J (1993) Subcortical infarcts. In Fisher M, Bogousslavsky J (eds) Current review of cerebrovascular diasease. Current Medicine, Philadelphia, pp 31-40 Bogousslavsky J, Caplan LR (1993) Vertebrobasilar occlusive disease review of selected aspects. 3 thalamic infarcts. Cerebrovasc Dis 3 193-205... 

Lee PH, Bang OY, Oh SH et al (2003) Subcortical white matter infarcts. Comparison of superficial perforating artery and internal borderzone infarcts using diffusion-weighted magnetic resonance imaging. Stroke 34 2630-2635 Leys D, Mounier-Vehier F, Lavenu I et al (1994) Anterior choroidal artery territory infarcts. Study of presumed mechanisms. Stroke 25 837-842... 

Min WK, Park KK, Kim YS et al (2000) Atherothrombotic middle cerebral artery territory infarction. Topographic diversity with common occurrence of concomitant small cortical and subcortical infarcts. Stroke 31 2055-2061 Minematsu K, Yamaguchi T, Omae T (1992) Spectacular shrinking deficit rapid recovery from a major hemispheric syndrome by migration of an embolus. Neurology 42 157-162... 

Fig 15.1. Diffusion-weighted imaging demonstrates different patterns of acute stroke in occlusive internal carotid artery disease 1, territorial stroke 2, subcortical stroke 3, territorial stroke with fragmentation 4, disseminated small lesions 5, borderzone infarction... 

Szabo et al. (2001) 102 >50 or occlusion Territorial stroke (n=30) Subcortical stroke ( =13) Territorial infarction with fragmentation (n=ll) Disseminated small lesions (n=15) Borderzone lesions (n=33) The degree of ICA stenosis may favor certain stroke patterns. In patients with high-grade stenosis the highest frequency of lesions occurs in the hemodynamic risk zones... 

Nakano S, Yokogami K, Ohta H et al (1995) CT-defined large subcortical infarcts correlation of location with site of cerebrovascular occlusive disease. AJNR 16 1581-1585 Neumann-Haefelin T, Wittsack HJ, Fink GR et al (2000) Diffusion- and perfusion-weighted MRI. Influence of severe carotid artery stenosis on the DWI/PI mismatch in acute stroke. Stroke 31 1311-1317... 

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy... 

Jung HH, Bassetti C, Tournier-Lasserve E et al. (1995). Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy a clinicopathological... 

---