J Clin Neurol.  2006 Sep;2(3):171-178. 10.3988/jcn.2006.2.3.171.

Analysis of the Lesion Distributions and Mechanism of Acute Middle Cerebral Artery Infarctions Involving the Striatocapsular Region

• Lee KB
• Roh H
• Park HK
• Sung KB
• Ahn MY

• KMID: 2287690
• DOI: http://doi.org/10.3988/jcn.2006.2.3.171

Abstract

BACKGROUND AND PURPOSE
There is no clear description about the patterns of each mechanism of striatocapsular infarctions. The aims of our study were to elucidate differences in the distributions of lesions of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease.
METHODS
We prospectively enrolled patients with acute infarcts located in the lenticulostriate artery territory that were not lacunar infarcts. Brain coronal diffusion-weighted imaging (DWI) was obtained and magnetic resonance angiography (MRA) was carried out to evaluate the distribution of infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into three categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE), and (3) dominant in the proximal territory. We performed tests for embolic sources (transthoracic echocardiography, transesophageal echocardiography, Holter monitoring, and contrast-enhanced MRA including the aortic arch) in most patients. Stroke mechanisms were classified into stroke from proximal embolism, MCA disease, and stroke of undetermined etiology.
RESULTS
A total of 47 patients (28 men and 19 women; mean age, 62 years) were recruited. A proximal embolic source was significantly more prevalent in patients with a DE lesion than in those with a DD lesion. The most common proximal embolic source was of cardiac origin. In contrast, symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion.
CONCLUSIONS
These results suggest that the dominant area of striatocapsular infarction on coronal DWI is an important clue for stroke etiology. Coronal DWI could therefore be helpful to determining the mechanisms in patients with striatocapsular infarctions that are currently described as having an "undetermined etiology" according to the Trial of Org 10172 in Acute Stroke Treatment classification.

Keyword

Striatocapsular infarction; MCA; Lenticulostriate artery; TOAST; Coronal DWI

MeSH Terms

Arteries
Brain
Classification
Constriction, Pathologic
Echocardiography
Echocardiography, Transesophageal
Electrocardiography, Ambulatory
Embolism
Female
Humans
Infarction*
Magnetic Resonance Angiography
Male
Middle Cerebral Artery*
Prospective Studies
Stroke
Stroke, Lacunar

Figure

• 

  Figure 1 Three types of lesion distribution of acute MCA infarction involving the striatocapsular region on axial/coronal DWI. (A) DD lesions appear as larger, high-intensity areas in the distal lenticulostriate territory, and are associated with MCA M1 stenosis (arrow). (B) DE lesions appear as 'comma-like shape' occupying an area of similar size in both the distal and proximal territories. (C) DP lesions are more prominent in the proximal territory. A typical lacunar infarction (D) which has <1.5 cm oval shape of high intensities on coronal DWI was excluded.

• 

  Figure 2 Definition of the boundary line (red arrow) that divides the proximal and distal territories. The line was the exact half of the total length of the perforator in each section (A), based on the coronal template 25 of the lenticulostriate artery territories (B). NC; caudate nucleus, TH; thalamus, PU; putamen

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