Association between middle cerebral artery and it's single infarction in the territory of perforating arteries

Abstract

Objective To analyze the morphologic characteristics of the single infarct in the territory of perforating arteries which arise from the middle cerebral artery (MCA),and further to investigate the association between the type of cerebral infarction and the isolated stenotic disease of the ipsilateral MCA.Methods Fifty-five patients with acute ischemic stroke who were admitted to the Department of Neurology,Peking Union Medical College Hospital,Beijing,China during January 1,2005 and December 31,2006 were identified.All of the patients had a single acute infarction in the territory of the MCA perforating arteries revealed on diffusion weighted imaging (DWI).Transcranial Doppler (TCD) and magnetic resonance angiography (MRA) were performed for all patients.Patients with stenesis >50% of proximal internal carotid artery and potential cardiac sources of embolism were excluded from the study.Patients were classified into 2 groups according to the presence of the atberosclerotic stenosis of the ipsilateral MCA: patients with or without MCA stenosis.Size of the lesions was measured including the diameter,area and volume.The infarcts with a diameter less than 2 cm were classified as lacunar infarcts; those bigger than 2 cm were classified as the striatocapsular infarcts.The infarcts on DWI was seen in basal ganglia,the body of lateral ventricle and beth.The concomitance of subcortical multiple small old infarcts or leucoariosis on T2>WI-MRI between the two groups was assessed.Results Among these 55 patients,14 (25.5%) had stenosis of the ipsilateral MCA and 41 (74.5%) had a normal MCA.In the group of MCA stenosis,71.4% patients were lacunar infarcts; 67.3% patients were also lacunar infarcts in the normal MCA group.There was no significant difference between the two groups (χ2=0.147,P=0.701).No significant difference in the diameter,area and vo|ume of the infarcts was found between the two groups.The basal ganglia,the body of lateral ventricle and both of these places involvement accounted for 31.7% ,17.1%,51.2% in the normal MCA group; 35.7%,28.6%,35.7% in the stenotic MCA group.No significant difference was found (χ2=1.272,P=0.529).Twenty-three (56.1%) patients had concomitant of small old subcortical multiple infarcts or leucoariosis in the normal MCA group and 3 (21.4%) in the MCA stenosis group,and there was a significant difference between the two groups(χ2=5.033,P=0.025).Conclusions A series of pathologic mechanisms are supposed to cause the single infarction in the territory of MCA perforating arteries.Stenosis of MCA is an underlying cause in addition to perforating artery diseases.There is no significant difference in the size,volume or distribution of the lesions between the two groups.The concomitant of subcortical multiple small old infarcts or leucoariosis may demonstrate the perforating artery disease. Key words: Brain infarction; Middle cerebral artery; Constriction,pathologic