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Lacunar infarction as an embolic complication of cardiac and arch angiography
1Department of Internal Medicine, University of Florida Health Science Center/Jacksonville.
Insights
This study presents two cases where pure motor hemiplegia, a lacunar stroke syndrome, developed during cardiac angiography, suggesting an embolic cause for lacunar infarction.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Embolic Stroke
Background:
- Lacunar infarcts are small, deep cerebral infarcts often linked to hypertension.
- The embolic origin of lacunar infarction remains debated, lacking direct causal proof.
- Cardiac embolization is a potential, though unproven, cause of lacunar syndromes.
Observation:
- Two patients developed pure motor hemiplegia during cardiac or aortic arch angiography.
- Neither patient had prior stroke or transient ischemic attack history.
- Initial brain CT scans were normal; one later showed a lesion consistent with infarction.
Findings:
- The presented cases suggest that emboli can precipitate lacunar stroke syndromes.
- Pure motor hemiplegia, a classic lacunar stroke, was observed to have an embolic basis.
- Cerebral infarction occurred in a patient undergoing arterial imaging procedures.
Implications:
- These findings support the hypothesis that emboli can cause lacunar infarction.
- The study highlights a potential mechanism for lacunar stroke in specific clinical contexts.
- Further research may elucidate the role of emboli in lacunar stroke etiology.
Background:
Lacunar infarcts are small, deep cerebral infarcts resulting from occlusion of small, penetrating cerebral arteries. They are most commonly associated with hypertension. Cardiac sources of embolization are sometimes present in patients with lacunes, but direct proof of a causal relationship is lacking. This report attempts to support the contention that emboli can cause lacunar syndromes and lacunar infarction.
Case Descriptions:
We report two cases of pure motor hemiplegia, each of which developed while the patient was undergoing cardiac or aortic arch angiography. Neither patient had a history of previous transient ischemic attack or stroke. Initial computed tomography of the brain was normal in each. Repeat computed tomography in one confirmed a small, low-density lesion in the posterior limb of the internal capsule on the side appropriate to the patient's symptoms and remained normal in the second patient.
Conclusions:
These two cases offer evidence that the classic lacunar stroke syndrome of pure motor hemiplegia can occur on an embolic basis.