Deep Lacunar Research Articles

Cerebral microbleeds is a predictor of recurrent small vessel cerebrovascular disease: Evaluation based on the recurrent stroke pattern

ObjectivesAn increased number of cerebral microbleeds (CMBs) is considered a predictive factor for recurrent small vessel cerebrovascular diseases, including lacunar infarction and non-lobar intracerebral hemorrhage (ICH). However, it is unclear which recurrent stroke pattern is mainly reflected in the number of CMBs. Materials and MethodsThis study enrolled 217 patients with their first stroke (148 deep lacunar infarctions and 69 non-lobar ICHs), between January 2009 and March 2015. The numbers of baseline and newly appearing CMBs in patients with recurrent stroke were compared with those in patients with non-recurrent stroke, and the dynamics of the number of CMBs was evaluated according to recurrent stroke patterns. ResultsFifty-nine patients with recurrent stroke were included in this study. A larger number of baseline and newly appearing CMBs was significantly associated with recurrent stroke (p = 0.04, p < 0.001, respectively). Recurrent stroke patterns were divided into four types: deep lacunar infarction/deep lacunar infarction (37 patients), deep lacunar infarction/non-lobar ICH (eight patients), non-lobar ICH/deep lacunar infarction (eight patients), and non-lobar ICH/non-lobar ICH (six patients). The number of newly appearing CMBs was significantly higher in patients with deep lacunar infarction/non-lobar ICH than in those with other recurrent stroke patterns (p = 0.04). ConclusionsThe number of CMBs is associated with recurrent stroke, including deep lacunar infarction and non-lobar ICH, and differs depending on the recurrent stroke patterns. The increase in the number of CMBs was strongly correlated with the deep lacunar infarction/non-lobar ICH recurrence pattern.

Acute Magnetic Resonance Imaging Findings in Young Children With Moyamoya Disease

BackgroundTo describe the diffusion-weighted imaging (DWI) findings in young children with moyamoya disease (MMD) during the acute period of the condition. MethodsClinical data were collected from 12 children with MMD aged less than six years, in whom abnormalities were observed on DWI scans obtained within one week after the appearance of symptoms related to MMD. The DWI abnormalities were classified into gyral, atypical territorial, honeycomb, classical territorial, multiple-dot, border zone, and deep lacunar patterns. The severity of arterial stenosis was graded by angiographic stages that have been previously described. ResultsIn all but one child, the DWI abnormalities were restricted to the cerebral cortex. The lesions were gyral in nature in seven children and atypical territorial in five; all differed from those of typical arterial strokes. Internal carotid artery stenosis was observed in all 12 children, although the stenosis was mild in 11. The severity of arterial stenosis did not match the regions of ischemic lesions in some children. There was no statistically significant difference in the severity of arterial stenosis according to the presence or absence of ischemic lesions or the pattern of the lesions. ConclusionsLesions located mainly in the cerebral cortex, i.e., not in arterial territories, are characteristic of young children with MMD.

COVID-19 ile İlişkili İskemik İnmenin Görüntüleme Bulguları

Objective: We aimed to present the relationship between ischemic stroke and COVID-19, stroke types, and imaging findings in COVID-19 with stroke. Material Method: From March to November 2020, COVID-19 diagnosed in patients with stroke (n=10) was included in the study retrospectively. To eliminate intracranial hemorrhage, a non-contrast computed tomography (CT) was performed for all patients. Then, magnetic resonance imaging (MRI) and Diffusion-Weighted MRI (DWI) (n=10) were obtained. Magnetic resonance angiography was performed in patients whose CT angiography was contraindicated. Clinical information, stroke risk factors, and case imaging results were recorded. Stroke time, size, location (cortical, deep lacunar, and white matter), and vascular territory area were evaluated. Results: The mean age of the 10 patients included in the study was 62±15.10 years. All patients had an ischemic stroke. In total, 4 cases (40%) did not have any risk factors for cerebral vascular disease. Based on DWI results, seven cases were assessed as acute strokes (70%) and three cases as sub-acute strokes (30%). The size of the stroke was 21.80±15.83mm. In 4 cases, the size was extended cortical areas. 3 cases were cortical, 5 cases had a lacunar infarction, 2 cases had cortical and lacunar infarctions. 6 cases were in the posterior cerebral artery territory and 4 cases were in the anterior territory. Conclusion: The presentation of patients with stroke during COVID-19 therapy or after therapy might be considered the hypothesis that the virus led to a stroke, especially in cases accompanied by risk factors.

Cavitation of Deep Lacunar Infarcts in Patients With First-Ever Lacunar Stroke

Studies in patients with lacunar stroke often assess the number of lacunes. However, data on how many symptomatic lacunar infarcts cavitate into a lacune are limited. We assessed the evolution of symptomatic lacunar infarcts over 2-year follow-up. In 82 patients with first-ever lacunar stroke with a lacunar infarct in the deep brain regions (excluding the centrum semiovale), we performed a brain MR at presentation and 2 years later. We classified cavitation of lacunar infarcts at baseline and on follow-up MR as absent, incomplete, or complete. We recorded time to imaging, infarct size, and vascular risk factors. On baseline MR, 38 (46%) index infarcts showed complete or incomplete cavitation. Median time to imaging was 8 (0-73) days in noncavitated and 63 (1-184) days in cavitated lesions (P<0.05). On follow-up imaging, 94% of the lacunar infarcts were completely or incompletely cavitated, most had reduced in diameter, and 5 (6%) had disappeared. Vascular risk factors were not associated with cavitation. Cavitation and lesion shrinkage were seen in almost all symptomatic lacunar infarcts in the deep brain regions over 2-year follow-up. Counting lacunes in these specific regions at a random moment might slightly, however not substantially, underestimate the burden of deep lacunar infarction.