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Infarcts of a Cardioembolic Source Mimicking Lacunar Infarcts: Case Series With Clinical and Radiological Correlation

Ahmed Harazeen1, Muhammad Z Memon1, Heitor Frade1

  • 1Neurology, University of Texas Medical Branch, Galveston, USA.

Cureus
|September 19, 2023
PubMed

Insights

Cardioembolic strokes can mimic lacunar infarcts, challenging traditional understanding of cerebral small vessel disease. This study highlights cases where cardiac catheterization led to stroke with lacunar features, suggesting a need for broader diagnostic considerations.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Neurology

Background:

  • Lacunar strokes are typically associated with cerebral small vessel disease.
  • Established pathogenic mechanisms for lacunar stroke exist, but cardioembolic causes are less understood.
  • Cerebral small vessel disease affects small arteries, arterioles, and capillaries in the brain.

Observation:

  • Three cases of acute ischemic stroke were observed after elective cardiac and cerebral catheterization.
  • Neuroimaging revealed infarcts with typical lacunar appearances in these patients.
  • A strong embolic source with temporal correlation to the procedures was evident.

Findings:

  • The reported cases demonstrate that cardioembolic events can result in infarcts that resemble lacunar strokes.
  • This challenges the conventional view that lacunar infarcts are exclusively caused by small vessel disease.
  • The findings suggest an overlap in imaging and clinical presentation between different stroke etiologies.

Implications:

  • Increased awareness of cardioembolic mechanisms in lacunar-appearing strokes is crucial for accurate diagnosis.
  • This understanding may refine the investigational workup for patients presenting with lacunar infarcts.
  • Clinical management strategies for stroke patients may need to be adapted to consider potential cardioembolic sources.

Keywords:
clinical correlationembolic sourceheart catheterization complicationslacunar infarctsradiological correlation

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