Cortical border-zone infarcts: clinical features, causes and outcome.
OBJECTIVE
To report the clinical features, causes and outcome of cerebral cortical border-zone infarcts BZI (C-BZI).


METHODS
The authors prospectively included patients with MRI-confirmed C-BZI among individuals consecutively admitted in Stroke Unit.


RESULTS
Forty-five patients presented C-BZI out of 589 with MRI-confirmed cerebral infarcts (7.6%). Particular clinical characteristics existed in C-BZI in comparison with other cerebral infarctions as a whole, including: (1) frequent transient symptoms at onset (27% vs 9%; p<0.001) and low severity score (NIHSS=3.1±3.0 vs 5.2±6.1; p=0.02); (2) early seizures in first 2 weeks (7/45 (15.6%) vs 12/544 (2.2%); p<0.001), even when focusing only on other infarctions involving the cerebral cortex (15.6% vs 4.3%; p<0.01); (3) heterogeneous clinical presentation but specific transcortical aphasia allowing a clinical suspicion of BZI before MRI; and (4) frequently associated internal carotid disease (69%), with subsequent early surgery in 75% of the cases. Following adapted care in stroke unit, C-BZIs' prognosis appeared good (Rankin score ≤2 at D90) for 82% of the patients.


CONCLUSIONS
Some clinical features are overrepresented in such infarctions, including initial transient symptoms preceding the onset of a completed deficit, transcortical aphasia and early seizures. Despite lower initial severity, C-BZIs justify early management in stroke unit, often followed by carotid surgery, leading to an overall good prognosis.
Department of Neurology, Bicêtre Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France.
Claire
C
Joinlambert
Guillaume
G
Saliou
Constance
C
Flamand-Roze
Pascal
P
Masnou
Mariana
M
Sarov
Raphaelle
R
Souillard
Marie
M
Saliou-Théaudin
Thierry
T
Guedj
Patrick
P
Assayag
Denis
D
Ducreux
David
D
Adams
Christian
C
Denier
D000368:Aged; D001037:Aphasia / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications; D002540:Cerebral Cortex / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D012720:Severity of Illness Index