Small vessel infarction

Small vessel/lacunar strokes have better short- and long-term (1-year) survival as compared to other stroke subtypes. In the NINDS trial of rt-PA within 3 hours of onset, patients classified as small vessel stroke on the basis of their clinical syndrome had a 50% chance of a normal NIHSS score at 3 months if they received placebo, increasing to 70% in the treatment group. In the Lausanne cohort, 95% were independent after their first event, as opposed to only 65% of the cardioembolic strokes and 49% with large vessel atherothrombotic infarctions. Eighty-two percent of patients with small vessel stroke were independent at 1 year. Even at the time of maximal deficit, between 38% and 64% of small vessel/lacunar patients were independent, with motor impairment and extent of white matter disease adversely affecting outcomes. " In TOAST, small vessel/lacunar stroke was the only subtype associated with a favorable outcome, independent of the NIHSS score. ... 

Brazis PW, Masdeu JC, Biller J (1990) Localization in clinical neurology, 3rd edn. Little Brown, Boston Bruno A, Graff-Radford NR, Biller J et al (1989) Anterior choroidal artery territory infarction a small vessel disease. Stroke 20 616-619... 

Aphasia and neglect can be found following respectively dominant and non-dominant anterior choroidal artery infarcts. Anterior choroidal artery infarcts usually cause the classical 3H syndrome hemiparesis, hemihypesthesia, hemianopia. Pure motor hemiparesis and isolated hemianopia can also occur (Han et al. 2000). Anterior choroidal artery territory infarcts are rarely caused by small vessel occlusion. In general they are caused by cardioembolism or large artery disease with occlusion or artery-to-artery embolism (Leys et al. 1994). 

Stroke localization using clinical data is not infallible in about one-quarter of cases where a recent lesion is visible on brain imaging, it is not in the expected place (Mead et al. 1999). For example, although most pure motor strokes are caused by a lacunar infarct as a result of small vessel disease, in a few cases the CT or MR scan shows striatocapsular infarction caused by middle cerebral artery occlusion with good cortical collaterals... 

Lacunar syndromes are defined clinically. They are highly predictive of small, deep lesions affecting the motor and/or sensory pathways in the corona radiata, internal capsule, thalamus, cerebral peduncle or pons. Although a few patients have a partial anterior circulation infarct (Bamford et al. 1987 Anzalone and Landi 1989 Arboix et al. 2007), the great majority have small iirfarcts, which are sometimes visible on CT, more often on MRI. These are caused by presumed occlusion of a small perforating artery affected by intracranial small vessel disease (see Fig. 10.2). There is no visual field defect, no new cortical... 

Small deep infarcts in the subcortical white matter of the corona radiata may result from small vessel disease affecting the long medullary perforating arteries extending down from cortical branches of the middle cerebral artery or from embolism. Such centrum semiovale infarcts present as either a lacunar syndrome or, occasionally, as a partial anterior cirulation syndrome with cortical features (Read et al. 1998 Lammie and Wardlaw 1999). They are not, however, easy to classify or to distinguish from border zone infarcts deeper in the white matter lying between the arterial territories of the deep perforators from the first part of the middle cerebral artery and the superficial medullary perforators. 

Eleven patients referred for neurological evaluation after cisplatin infusion into the internal or external iliac arteries for pelvic or lower limb tumors aU developed symptoms within 48 hours of nerve or plexus dysfunction within the territory supplied by the cannulated artery (108). The lumbosacral plexus was affected in nine patients, the femoral nerve in one, and the peroneal nerve in one. The doses of cisplatin ranged from 50 to 160 mg/m and they did not correlate with the severity or course of the neuropathy. Small-vessel injury and infarction or a direct toxic effect are likely explanations. 

Aminorex fumarate Aspirin Intimai and medical thickening of pulmonary arteries Endothelial damage, gastric erosion obliteration of small vessels, ischemic infarcts Pulmonary hypertension... 

Cerebrovascular disease is a consequence of hypertension. A neurologic assessment can detect either gross neurologic deficits or a slight hemiparesis with some incoordination and hyperreflexia that are indicative of cerebrovascular disease. Stroke can result from lacunar infarcts caused by thrombotic occlusion of small vessels or intracerebral hemorrhage resulting from ruptured microaneurysms. Transient ischemic attacks secondary to atherosclerotic disease in the carotid arteries are common in hypertensive individuals. 

Vasculitis usually is seen in patients with long-standing rheumatoid arthritis. Vasculitis may result in a wide variety of clinical presentations. Invasion of blood vessel walls by inflammatory cells results in an obliteration of the vessel, producing infarction of tissue distal to the area of involvement. Most commonly, small-vessel vasculitis produces infarcts near the ends of the fingers or toes, especially around the nail beds. These infarcts are usually of little consequence. 

Vascular dementia (multi-iirfarct dementia, small vessel dementia, infarcts of... 

Performing a standard coronary CTA, CT density values within the myocardium can give insight into pathologic ischemia of the myocardium, i.e., hypoperfusion or myocardial infarction, both reflected by a reduced CT density or hypoattenuation. Ischemic changes in the myocardium after coronary arterial occlusion consist of disruption of cell membrane function and integrity and increased permeability of small vessel walls. In contrast-enhanced CT, the initial area of low attenuation primarily reflects myocardial edema, i.e., a pronounced water content of the myocardium, which is followed by infiltration of inflammatory cells. Subsequently, necrotic myocardium is replaced by fibrous and/or fatty... 

Patients with multiple vascular injuries are candidates for either proximal coil embolization or combined therapy, wdiich utilizes selective catheterization and embolization of the most significantly injured vessels followed by proximal coil embolization [2]. In these patients, distal embolization since this may require extensive fluoroscopic exposure times to catheterize multiple small vessels with subsequent infarction of too large a percentage of splenic parenchyma. Haan et al. found no difference in failure rate when proximal embolization was compared with more selective, distal embolization. Interestingly, however, the largest failure rate was found when both techniques were utilized in... 

BD can have a diverse range of pulmonary parenchymal manifestations that include lung infarctions, or, less commonly, small-vessel vasculitis, eosinophilic pneumonia, interstitial pneumonitis, bronchiolitis obliterans organizing pneumonia, and pulmonary fibrosis (19,20). 

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