Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology.?

Citation
Jm. Wardlaw et al., Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: Occlusion or other vascular pathology.?, ANN NEUROL, 50(2), 2001, pp. 208-215
Citations number
29
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
ANNALS OF NEUROLOGY
ISSN journal
0364-5134 → ACNP
Volume
50
Issue
2
Year of publication
2001
Pages
208 - 215
Database
ISI
SICI code
0364-5134(200108)50:2<208:IAOTSP>2.0.ZU;2-O
Abstract
Lacunar infarction is associated with distinct clinical features. It is tho ught to result from occlusion of a deep perforating artery in the basal gan glia, centrum sentiovale, or brain stem. However, occluded perforating arte ries have only rarefy been observed at postmortem in patients with lacunar stroke and have not been noted previously on imaging despite the increasing sophistication of the techniques. We observed nine patients with lacunar s troke imaged with computed tomography and magnetic resonance imaging in who m we observed a linear structure with density or signal features consistent with an occluded (or at least abnormal) perforating artery associated with the relevant lacunar infarct. The appearance might also have been caused b y a leak of blood and fluid into the perivascular space around the artery, as in several patients the width of the tubular vessel-like structure (>1 m m in diameter) was greater than the expected width of a perforating artery (<0.8 mm in diameter). This interpretation is supported by the fact that th e area of infarction was usually around the abnormal vessel, not at the end of it. We describe the patients' clinical and imaging features, and discus s alternative explanations for the imaging appearance and the implications for gaining insights into the cause of lacunar infarction.