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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Brain infarcts in the arterial border zones: Clinical-pathologic correlations
J L Martí-Vilalta1, A Arboix2, J H Garcia3
1From the Department of Neurology, Hospital Santa Creu i Sant Pau, Universidad Autónoma, Hospital Central La Alianza, Barcelona, Spain.
Insights
Nonocclusive causes of brain infarcts, particularly hemodynamic crises, lead to arterial border-zone infarcts. These can manifest as distinct neurologic syndromes, including the "man-in-a-barrel" syndrome from anterior cerebral artery border-zone ischemia.
Area of Science:
- Neurology
- Cerebrovascular Diseases
- Neuroscience
Background:
- Most brain infarcts result from arterial occlusion.
- Nonocclusive causes of brain infarcts are less understood but clinically significant.
- Hemodynamic crises, often cardiac in origin, are a key nonocclusive cause.
Purpose of the Study:
- To review mechanisms and clinical presentations of brain infarcts from nonocclusive causes.
- To elucidate the pathophysiology of arterial border-zone infarcts.
- To describe associated neurologic syndromes.
Main Methods:
- Review of selected publications on nonocclusive brain infarcts.
- Analysis of mechanisms and clinical expressions.
- Correlation of infarct distribution with neurologic syndromes.
Main Results:
- Hemodynamic crises are a primary cause of arterial border-zone infarcts.
- Three distinct neurologic syndromes are associated with these infarcts.
- The "man-in-a-barrel" syndrome results from bilateral anterior border-zone infarcts affecting proximal limb muscles.
Conclusions:
- Nonocclusive factors, especially hemodynamic instability, are critical in brain infarct etiology.
- Arterial border-zone infarcts present with specific, identifiable neurologic syndromes.
- Understanding these syndromes aids in diagnosing and managing nonocclusive cerebrovascular events.
Abstract:
Most brain infarcts are correctly attributed to the circulatory alterations caused by the occlusion of a vessel, usually arterial. In this article, the authors review selected publications dealing with the mechanisms and the clinical expressions of brain infarcts secondary to nonocclusive causes. Hemodynamic crises, usually of cardiac origin, are among the main causes of the so-called arterial border-zone infarcts of the brain. Depending on the etiology and the distribution of the brain lesions, at least three separate neurologic syndromes have been outlined. The most frequently observed syndrome is attributed to the involvement, by the ischemic event, of tissues located in the border zone between the territories of the anterior and middle cerebral arteries. These anterior, bilateral arterial-border-zone infarcts produce a syndrome of bilateral brachial paralysis, with maximal involvement of the proximal limbs musculature, i.e., the "man-in-a-barrel" syndrome. Other neurologic syndromes in patients with arterial-border-zone infarcts are associated with ischemic injury of specific anatomic sites.
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