[Neuroradiological analysis of small infarcts in deep subcortical structure detected by CT].
We studied angiographic findings of 56 patients who were diagnosed as lacunar infarcts in the basal ganglia or deep subcortical white matter based on clinical symptomatology and brain computed tomography. In 26 patients with CT lesions less than 15 mm in diameter, only eight (31%) showed minor angiographic findings. In 30 patients with lesion of 15 mm or more, however, 22 (73%) had abnormal angiographic findings. Fourteen of the 22 patients had minor irregularities, three had 25-75% stenosis, five had 75% less than stenosis at the bifurcation of the common carotid artery or the horizontal portion of the middle cerebral artery. Our findings support the notion that a small lesion on CT can result from an occlusion of the perforating artery itself and a larger lesion is much related to the major vessel or heart diseases, i.e., emboli from the parent artery or heart, obstruction of perforators at their origin by an atheromatous plaque of the horizontal portion of the middle cerebral artery, or terminal zone infarct due to hemodynamically significant stenotic lesion. In patients with a larger deep infarct on CT, further investigation of the arteries in the carotid-axis and heart is important for determination of therapeutic indication.
Department of Medicine, National Cardiovascular Center.
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Kimura
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Yamaguchi
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Yasaka
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002536:Cerebral Arteries; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed