Infarct territorial

Hemorrhage or well-established acute infarct on CT involving greater than one third of the affected vascular territory. 

Malignant or life-threatening MCA territory infarction occurs in up to 10% of strokes and is associated with an 80% mortality rate. Stroke progression and... 

Curry Jr, WT, Sethi MK, Ogilvy CS, Carter BS. Factors associated with outcome after hemicraniectomy for large middle cerebral artery territory infarction. Neurosurgery 2005 56 681-692 [discussion 681-692]. 

Wijdicks EE, Diringer MN. Middle cerebral artery territory infarction and early brain swelling progression and effect of age on outcome. Mayo Clin Proc 1998 73 829-836. 

Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction a systematic review. Stroke 2004 35(2) 539-543. 

De Reuck J, Goethals M. Claeys I, Van Maele G, De Clerck M, EEG findings after a cerebral territorial infarct in patients who develop early- and late-onset seizures. Eur Neurol 2006 55(4) 209-213. 

Cardioembolism Cardioembolism accounts for approximately 30% of all stroke and 25-30% of strokes in the young (age <45 years)." AF accounts for a large proportion of these strokes (15-25%). Symptoms may be suggestive, but they are not diagnostic. Repetitive, stereotyped, transient ischemic attacks (TIAs) are unusual in embolic stroke. The classic presentation for cardioembolism is the sudden onset of maximal symptoms. The size of the embolic material determines, in part, the course of the embolic material. Small emboli can cause retinal ischemic or lacunar symptoms. Posterior cerebral artery territory infarcts, in particular, are often due to cardiac embolism. This predilection is not completely consistent across the various cardiac structural abnormalities that predispose to stroke, and may be due to patterns of blood flow associated with specific cardiac pathologies. 

Complete occlusion of the MCA trunk with infarction of the entire MCA territory is a potentially devastating situation with severe paralysis, hemisensory loss, attentional hemianopia, conjugate eye deviation, and global aphasia in left sided lesions (Hacke et al. 1996). Because of its high mortality this type of... 

With involvement of the cerebellar hemisphere supplied by the PICA, subsequent edema may cause obstruction of the 4th ventricle, hydrocephalus or compression of the medulla oblongata. Clinically, involvement of the entire cerebellar hemisphere can not be distinguished from partial cerebellar infarction (Amarenco and Hauw 1990). Therefore patients with neurological symptoms suggesting infarction within the PICA territory require neuroimaging studies and close clinical monitoring. 

Historically, the French neurologist Charles Foix in 1923 first described the syndrome of infarction in the PCA territory as a thalamocapsular deficit (Foix and Masson 1923). The PCAs arise from the BA, but about 30% of patients have a hypo- or aplastic PI segment with the PCA nourished by the ICA through the posterior communicating artery (Margolis et al. 1971). 

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