Morphometrische Differenzierung subkortikaler zerebraler Infarkte

Abstract

Three pathogenetic types of cerebral infarcts can be differentiated in the territories of the deep perforators: lacunae, large striatocapsular infarcts and “low flow infarcts”. The aim of the study was to show if a morphologic differentiation of the latter two macroangiopathic types of infarcts is possible. MRI/CT was compared in 18 subcortical infarcts due to embolic MCA occlusion (group A) and in 20 presumed haemodynamic subcortical infarcts (group B, ipsilateral ICA occlusion, decreased cerebral perfusion reserve [SPECT] and decreased CO2 reactivity of the MCA). The infarcts were entered into a standard grid model of brain shces and their anatomical distribution was compared with the subcortical vascular territories. In group A, basal ganglia, internal capsule and corona radiata were infarcted, mimicking a template of the supply-areas of the lenticulostriate arteries as a result of the simultaneous occlusion of these arteries at the M1 segment. In group B, the infarcts were restricted to the upper planes, forming a crescent-shaped rim in the terminal supply areas of the deep perforators in the subcortical deep white matter as a distant haemodynamic effect of extracranial vessel occlusion and insufficient intracranial collateralisation. There was an overlap of spatial distribution. The morphological distinction of embolic or haemodynamic subcortical infarcts is possible and should influence diagnostic and therapeutic strategies in stroke patients.