Cerebral border zone infarction: an etiological study

Tarek Mohammed El-Gammal,Ayman Mohammed Al-Malt,Wafik Said Bahnasy,Osama Abd Allah Ragab

doi:10.1186/s41983-018-0008-0

Tarek Mohammed El-Gammal, Ayman Mohammed Al-Malt + Show 2 more

Open Access

https://doi.org/10.1186/s41983-018-0008-0

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Abstract

BackgroundBorder zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI.MethodsThis study was conducted on 76 cerebral BZI patients and 20 healthy control subjects. Patients were divided to group I included 26 internal BZI, group II included 19 cortical BZI and group III included 21 mixed internal/cortical BZI patients. Included subjects were submitted to neurological examination, laboratory investigations, ECG, echocardiogram, brain CT and/or MRI and extra and intracranial blood vessels imaging by duplex and CT angiography.ResultsHypertension was significantly higher among groups I and III compared to group II while atrial fibrillation (AF) was significantly higher in groups II and III than group I (p < 0.05). Sonographic duplex assessment of extra and intracranial blood vessels revealed significant increase in mean flow velocities of CCA, ICC and MCA on both side in groups I and III compared to group II (p < 0.05). CT angiography revealed non-significant differences between BZI patients and control as well as in between the three BZI patient’s groups regarding the existence of vertebral artery hypoplasia and/or circle of Willis anomalies.ConclusionsVascular stenosis is the main etiological factor in internal BZI while AF is the predominant etiological factor of cortical BZI. Congenital vascular anomalies play roles in the localization of BZI but cannot predispose to it except when comorbid with hemodynamic disturbances.

Highlights

Border zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI
The study included 76 BZI patients divided to three groups: 26 internal BZI, 19 cortical BZI, and 21 mixed internal/cortical BZI
The present study revealed significant increase in the incidence of each of diabetes mellitus (DM), dyslipidemia, ischemic heart diseases, and previous cerebrovascular accidents in BZI patients compared to healthy control subjects (p values were < 0.001, < 0.001, 0.0032 and < 0.001 respectively)

Summary

Introduction

Border zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI. Border-zone infarctions (BZI) are ischemic lesions located at the junction between two arterial territories and represent about 10% of all brain infarcts (CauquilMichon et al 2011). Border-zone infarctions are either internal or external (cortical) BZI. The former appears as multiple infarcts in a rosary like pattern in the centrum semiovale and corona radiata while the latter are usually wedge shaped, located in the cerebral cortex between the territories of the three main cerebral arteries (Mangla et al 2011). The Circle of Willis (COW) is a major site of collateral flow but its anomalies are common affecting its ability to maintain sufficient perfusion and increasing the risk of BZI (Wang and Wang 2015)

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