[Hemodynamically induced cerebral infarcts. Clinical significance of infarct pattern and angiomorphology]

Classification of brain infarcts based on the location, size and shape of parenchymal damage alone can be difficult and misleading. This is particularly true in subcortical infarctions and infarcts in so-called watershed areas between neighboring territories of the main hemispheric arteries. Pathogenetic mechanisms, signs and symptoms, lesion patterns in CT and MRI are discussed as well as angiomorphological conditions. Hemodynamically induced low-flow infarcts are rare and show typical, but not pathognomic lesion patterns on CT and MRI. Characteristic subcortical chainlike and confluent lesions are located in the supra- and paraventricular white matter, representing the core of a hemodynamically induced infarction. Definite diagnosis of low-flow infarcts requires information on the underlying complex vascular compromise of the extra- and intracranial arterial circulation. A noncompetent circle of Willis is the main predisposing condition in hemispheric low-flow infarcts even in severe occlusive disease of the internal carotid arteries.