Can we discriminate stroke mechanisms by analyzing the infarct patterns in the striatocapsular region?
OBJECTIVE
The aims of our study were to elucidate the differences in the distribution of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease (MCAD).


METHODS
We prospectively enrolled patients with acute large infarcts located in the lenticulostriate artery territory. Brain coronal diffusion-weighted imaging (DWI) and magnetic resonance angiography were carried out in all patients. The types of infarct distribution were divided into 3 categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE) and (3) dominant in the proximal territory. Stroke mechanisms were classified into stroke from proximal embolism, MCAD and stroke of undetermined etiology.


RESULTS
A total of 71 patients were recruited. Proximal embolic sources were significantly more prevalent in patients with a DE lesion, but symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion.


CONCLUSIONS
These results suggest that the dominant area of striatocapsular infarctions on coronal DWI can be an important clue for stroke etiology.
Department of Neurology, Soonchunhyang University, College of Medicine, Seoul, Korea. kblee@hosp.sch.ac.kr
Kyung Bok
KB
Lee
Hyung Geun
HG
Oh
Hakjae
H
Roh
Moo Young
MY
Ahn
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic; D003342:Corpus Striatum / Q000098:blood supply / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000145:classification / Q000209:etiology* / Q000473:pathology; D020772:Internal Capsule / Q000098:blood supply / Q000473:pathology*; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D011446:Prospective Studies