Large vessel disease in Chinese patients with capsular infarcts and prior ipsilateral transient ischaemia

Carotid angiography was carried out in 21 Chinese patients with acute capsular infarcts; all had had a previous ipsilateral transient ischaemic attack (TIA) or reversible ischaemic neurological deficit (RIND) during the preceding 6 months. Sixteen (group 1) showed lacunar capsular infarcts, and 5 (group 2) either "giant lacunae" or "striatocapsular infarcts". Angiography showed that 81% of group 1 and all group 2 patients had ipsilateral severe stenosis or occlusion of either the M1 segment of the middle cerebral artery or the internal carotid artery. Ten group 1 patients and 3 group 2 patients also had contralateral intra- or extracranial carotid artery stenosis. Apart from hypertension, other risk factors such as hyperfibrinogenaemia, polycythaemia, and low HDL-cholesterol level seem to play a role. Haemorheological abnormalities in the presence of atherostenosis at the orifice of lenticulostriate arteries and/or artery-to-artery embolism might be the cause of infarcts in the majority of the patients. A fifth of patients had recurrent large ipsilateral infarcts. Thus capsular lacunar syndromes with prior ipsilateral TIA or RIND are not as benign as previously thought, and they should indicate more intensive studies including cerebral angiography, and more vigorous therapy.