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Stroke mechanisms and clinical presentation in large subcortical infarctions

D R Horowitz1, S Tuhrim

  • 1Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.

Neurology
|December 31, 1997
PubMed

Insights

Large subcortical strokes, often caused by embolism, frequently lead to cortical signs. This contrasts with small strokes, which typically stem from small-vessel disease and lack cortical findings.

Area of Science:

  • Neurology
  • Cerebrovascular Disease

Background:

  • Subcortical infarcts vary in cause and clinical presentation based on size.
  • Large subcortical infarcts are often embolic, while small ones typically result from small-vessel disease.

Purpose of the Study:

  • To investigate the embolic sources and clinical manifestations of large subcortical infarcts.
  • To determine the frequency of cortical signs such as aphasia, hemineglect, and gaze paresis in patients with large subcortical infarcts.

Main Methods:

  • Evaluation of 51 consecutive patients with CT-confirmed subcortical infarcts (≥1.5 cm).
  • Assessment for potential carotid or cardiac embolic sources.
  • Determination of the occurrence rates of aphasia, hemineglect, and gaze paresis.

Main Results:

  • An embolic source (carotid or cardiac) was identified in 63% of patients.
  • Carotid and cardiac sources accounted for 23% and 49% respectively.
  • Aphasia or hemineglect occurred in 39% of patients, and gaze paresis in 41%.

Conclusions:

  • Large subcortical strokes frequently originate from embolic events.
  • These strokes often present with distinct clinical syndromes and mechanisms compared to small subcortical strokes.

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