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Updated: Aug 14, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Pathogenesis of deep white matter medullary infarcts: a diffusion weighted magnetic resonance imaging study
1Department of Neurology, School of Medicine, Ajou University, Woncheon-dong San 5, Paldal-Ku, Suwon, Kyungki-do 442-749, South Korea.
Background And Purpose:
The pathogenesis of deep white matter medullary (WMM) artery infarcts remains controversial. To address this question, we analysed the stroke patterns of WMM infarcts using diffusion weighted magnetic resonance imaging (DWI) to detect embolic signals and investigate stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications.
Methods:
We identified WMM infarcts on DWI using templates to determine the subcortical vascular territories. We classified WMM infarcts into those with small artery disease (SAD), large artery disease (LAD), cardioembolism (CE), two or more aetiologies, or undetermined aetiology. Clinical course, risk factors, and cortical spotty lesions were compared.
Results:
Of the 1420 consecutive patients, 103 (7.3%) met the criteria for WMM infarcts. The stroke subtypes were as follows: 65 (63.1%) patients with LAD, 18 (17.5%) with SAD, 12 (11.7%) with CE, four (3.9%) with two or more aetiologies, three (2.1%) with undetermined aetiology, and one (1.0%) with other determined aetiology. LAD (87.7%) or CE (83.3%) was significantly accompanied by cortical embolic signals as compared to SAD (0%, p<0.001). The LAD infarcts were larger and tended to be chain-like in shape. Ischaemic stroke recurrence was more common in strokes with cortical embolic signals than in those without embolic signals (18.9% v 0%, p = 0.009).
Conclusions:
In present study, the most common pathogenesis of WMM infarcts was LAD. Our study indicates that WMM infarcts accompanying cortical embolic signals warrant evaluation of the underlying embolic sources in the large artery or the heart.
Insights
Large artery disease is the most common cause of white matter medullary artery infarcts. These infarcts, especially those with embolic signals, require evaluation for underlying cardiac or large artery sources.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- The origins of white matter medullary (WMM) artery infarcts are not fully understood.
- Investigating stroke patterns and subtypes is crucial for understanding WMM infarct pathogenesis.
Purpose of the Study:
- To analyze stroke patterns of WMM infarcts using diffusion-weighted magnetic resonance imaging (DWI).
- To detect embolic signals and classify WMM infarct subtypes according to TOAST criteria.
Main Methods:
- Identified WMM infarcts on DWI using templates to define subcortical vascular territories.
- Classified infarcts by stroke subtype: large artery disease (LAD), small artery disease (SAD), cardioembolism (CE), or other/undetermined aetiologies.
- Compared clinical course, risk factors, and cortical lesions.
Main Results:
- Out of 1420 patients, 103 (7.3%) had WMM infarcts.
- The most common subtype was LAD (63.1%), followed by SAD (17.5%) and CE (11.7%).
- LAD and CE infarcts were significantly associated with cortical embolic signals (p<0.001); LAD infarcts were larger and chain-like. Ischemic stroke recurrence was higher with embolic signals (18.9% vs 0%, p=0.009).
Conclusions:
- Large artery disease (LAD) is the predominant cause of WMM infarcts.
- WMM infarcts with cortical embolic signals necessitate investigation into potential embolic sources within the large artery or heart.
