Related Experiment Videos
[Neuroradiological analysis of small infarcts in deep subcortical structure detected by CT]
K Kimura1, T Yamaguchi, M Yasaka
1Department of Medicine, National Cardiovascular Center.
Insights
Larger deep brain infarcts detected by computed tomography (CT) are linked to major vessel or heart diseases. Smaller lesions may indicate perforating artery issues, necessitating further investigation for larger infarcts.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Lacunar infarcts affect the basal ganglia or deep subcortical white matter.
- Clinical symptomatology and brain computed tomography (CT) are used for diagnosis.
Purpose of the Study:
- To investigate the correlation between the size of lacunar infarcts on CT and angiographic findings.
- To determine the underlying causes of lacunar infarcts based on lesion size and location.
Main Methods:
- Retrospective analysis of 56 patients with diagnosed lacunar infarcts.
- Correlation of CT lesion diameter with angiographic findings (e.g., stenosis, irregularities).
Main Results:
- 31% of patients with CT lesions <15 mm showed minor angiographic findings.
- 73% of patients with CT lesions ≥15 mm had abnormal angiographic findings.
- Abnormal findings in larger lesions included stenosis and irregularities in major vessels or at the origin of perforating arteries.
Conclusions:
- Small CT lesions may result from perforating artery occlusion.
- Larger lesions are associated with major vessel diseases (e.g., carotid artery stenosis) or cardiac emboli.
- Further investigation of carotid arteries and the heart is crucial for patients with larger deep infarcts to guide therapy.
Abstract:
We studied angiographic findings of 56 patients who were diagnosed as lacunar infarcts in the basal ganglia or deep subcortical white matter based on clinical symptomatology and brain computed tomography. In 26 patients with CT lesions less than 15 mm in diameter, only eight (31%) showed minor angiographic findings. In 30 patients with lesion of 15 mm or more, however, 22 (73%) had abnormal angiographic findings. Fourteen of the 22 patients had minor irregularities, three had 25-75% stenosis, five had 75% less than stenosis at the bifurcation of the common carotid artery or the horizontal portion of the middle cerebral artery. Our findings support the notion that a small lesion on CT can result from an occlusion of the perforating artery itself and a larger lesion is much related to the major vessel or heart diseases, i.e., emboli from the parent artery or heart, obstruction of perforators at their origin by an atheromatous plaque of the horizontal portion of the middle cerebral artery, or terminal zone infarct due to hemodynamically significant stenotic lesion. In patients with a larger deep infarct on CT, further investigation of the arteries in the carotid-axis and heart is important for determination of therapeutic indication.