title: Stroke mechanisms and clinical presentation in large subcortical infarctions.
abstract: Large subcortical infarctions may be due to cerebral embolism and cause cortical signs more frequently than small subcortical infarctions, which usually result from small-vessel disease and are not associated with cortical findings. We evaluated 51 consecutive patients with a subcortical infarct on CT that was 1.5 cm or larger for a potential carotid or cardiac source of embolism and determined how frequently aphasia, hemineglect, or gaze paresis occurred. A carotid or cardiac embolic source was identified in 63% of the total population with a carotid source occurring in 23% and a cardiac source occurring in 49%. More than one-half of the patients with hypertension or diabetes mellitus had an embolic source, whereas all patients without these risk factors had a possible carotid or cardiac source of embolism. Aphasia or hemineglect occurred in 39% of patients and gaze paresis occurred in 41%. Large subcortical strokes frequently result in a different clinical syndrome and from a different mechanism than small subcortical strokes.
authors.affiliation: Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Horowitz
authors.forename: S
authors.initials: S
authors.lastname: Tuhrim
mesh_terms: D000368:Aged; D001037:Aphasia / Q000209:etiology; D001161:Arteriosclerosis / Q000150:complications / Q000175:diagnosis; D001288:Attention; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis; D002544:Cerebral Infarction / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D002542:Intracranial Embolism and Thrombosis / Q000150:complications / Q000209:etiology; D008297:Male; D009886:Ophthalmoplegia / Q000209:etiology; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial