title: Single subcortical infarction and atherosclerotic plaques in the middle cerebral artery: high-resolution magnetic resonance imaging findings.
abstract: OBJECTIVE
  Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its extension to the middle cerebral artery (MCA). We investigated the differences between pSSI and dSSI in terms of their clinical features, lesion size, and the frequency of MCA plaques detected by high-resolution MRI.
  
  
  METHODS
  Thirty-nine patients with SSI (20 pSSI and 19 dSSI) were prospectively enrolled who did not show relevant MCA disease on MR angiography. Lesion size, neurological status (initial National Institutes of Health Stroke Scale score and modified Rankin Scale at 3 months), and the presence and location (superior versus inferior) of high-resolution MRI-identified plaques were evaluated.
  
  
  RESULTS
  The frequencies of MCA plaques did not differ between patients with pSSI and those with dSSI (8 [40%] versus 12 [63.2%]; P=0.205); however, superiorly located plaques were significantly more common in patients with pSSI than in those with dSSI (6 [75%] versus 2 [16.7%]; P=0.019). Initial lesion volumes were larger (1.96±1.18 versus 1.11±1.11 mm(3); P=0.025), National Institutes of Health Stroke Scale scores were higher (5 [3-6.75] versus 3 [1-3] points; P=0.017), and microbleeds were fewer (1 [5%] versus 10 [52.6%]; P=0.001) in patients with pSSI than in those with dSSI. Three-month modified Rankin Scale scores were higher in patients with superior plaques than in those with inferior plaques.
  
  
  CONCLUSIONS
  Compared with dSSI, pSSI is closely associated with large lesions, severe clinical symptoms, and superiorly located MCA plaques, suggesting that the location, rather than simple presence of plaques, determines the SSI location.
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Youngshin
authors.initials: Y
authors.lastname: Yoon
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: cerebral infarction; high-resolution MRI; plaque, atherosclerotic