Occipital infarction: Carotid artery and cardiac findings

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Extracranial carotid artery disease can lead to occipital infarction, particularly when the posterior cerebral artery arises from the carotid artery.
• Occipital infarcts, often presenting as homonymous visual field defects, warrant investigation into their underlying causes.

Purpose of the Study:

• To ascertain the prevalence of significant extracranial carotid artery stenosis (≥50%) in patients experiencing posterior cerebral artery territory occipital infarcts.
• To identify the predominant stroke mechanisms contributing to occipital infarction in this patient cohort.

Main Methods:

• A cohort of 24 consecutive patients with recent occipital infarcts (confirmed by CT or MRI) was studied.
• Carotid artery evaluation included duplex ultrasound (17 patients) and arteriography (1 patient). Echocardiography was performed in 20 patients.
• Patients presented with homonymous visual field defects, with eight experiencing additional cerebral dysfunctions.

Main Results:

• None of the 18 patients who underwent carotid studies demonstrated extracranial carotid artery stenosis of 50% or greater.
• Cardiac embolism was identified as the most frequent presumed mechanism of infarction (42%), followed by undetermined causes (38%).
• Other identified mechanisms included hypercoagulability (8%), artery-to-artery embolism (4%), migraine (4%), and multiple potential mechanisms (4%).

Conclusions:

• Extracranial carotid artery disease is an infrequent cause of occipital infarction.
• Cardiac embolism remains the principal etiological factor for occipital infarcts, aligning with previous research findings.