Striatocapsular Infarction Research Articles

How Topographic Diffusion-Weighted Imaging Patterns can Predict thePotential Embolic Source.

To develop an imaging prediction model for patients with embolic stroke of undetermined source (ESUS), we investigated the association of topographic diffusion-weighted imaging (DWI) patterns with potential embolic sources (PES) identified by transesophageal echocardiography. From atotal of 992 consecutive patients with embolic stroke, 366 patients with the ESUS group were selected. ESUS was defined as no atrial fibrillation (Af) within 24h from admission and no PES after general examination. Clinical variables include age (> 80years, 70-80 years), sex, vascular risk factors and left atrial diameter > 4 cm. Age, sex and vascular risk factors adjusted odds ratio of each DWI for the different PESs were calculated. DWI was determined based on the arterial territories. Middle cerebral arteries were divided into 4segments, i.e., M1-M4. Moreover, M2segments were subdivided into superior and inferior branches. The 366 patients consisted of 168 with paroxysmal Af (pAf), 77with paradoxical embolism, 71with aortic embolism and 50with undetermined embolism after transesophageal echocardiography. The variables adjusted odds ratio (OR) of internal carotid artery (OR: 12.1, p = 0.037), M1(4.2, p = 0.001), inferior M2(7.5, p = 0.0041) and multiple cortical branches (12.6, p < 0.0001) were significantly higher in patients with pAf. Striatocapsular infarction (12.5, p < 0.0001) and posterior inferior cerebellar artery infarcts (3.6, p = 0.018) were significantly associated with paradoxical embolism. Clinical variables adjusted OR of multiple small scattered infarcts (8.3, p < 0.0001) were significantly higher in patients with aortic embolism. The associations of DWI with different PES have their distinctive characteristics and DWI along with clinical variables may help predict PES in patients with ESUS.

Frontal Lobe Syndrome Due to Striatocapsular Infarction

Frontal Lobe Syndrome Due to Striatocapsular Infarction

Minor Head Injury–Induced Striatocapsular Infarction in a 3-Year-Old Girl

Minor Head Injury–Induced Striatocapsular Infarction in a 3-Year-Old Girl

The correlation of embolic sources with infarct pattern in patients with embolic stroke (P6-5.015)

<h3>Objective:</h3> To exclusively identify potential embolic sources (PES) applying transesophageal echocardiography (TEE) and correlate them with topographic diffusion-weighted imaging patterns (DWI) in patients with embolic stroke. <h3>Background:</h3> Embolic stroke of undetermined source (ESUS) has been reported to show a relatively high stroke recurrence rate. Thus, early identification of potential embolic source (PES) is critical for acute treatment and/or secondary prevention. If acute topographic diffusion-weighted imaging patterns (DWI) would correlate with specific PES, it may prove very useful. <h3>Design/Methods:</h3> A total of 992 consecutive patients with embolic stroke were studied. Apart from the known embolic group (n=560), we focused on the unknown embolic group (n=366) that was defined as no arrhythmia during the first day from admission and no PES after general examination. DWI were classified based on the arterial supply. Age and sex adjusted odds ratio (OR) of each DWI for the different PESs were calculated. Middle cerebral arteries (MCA) were divided into 4 segments, i.e., M1~M4. Moreover, M2 segments were subdivided into superior and inferior branches. <h3>Results:</h3> 366 patients consisted of 168 with paroxysmal atrial fibrillation (pAf), 82 with paradoxical embolism (PxE), 71 with aorto-embolism (AoE), leaving 39 patients undetermined. The DWIs of internal carotid artery (OR: 15.0, p=0.0027), M1 (4.2, p=0.0003), inferior M2 (3.6, p=0.04) and multiple cortical branches (MCB) (21.6, p&lt;0.0001) were significantly associated with pAf. Striatocapsular infarction (SCI) (15.1, p&lt;0.0001) was significantly associated with PxE and multiple small scattered infarcts (8.6, p&lt;0.0001) with AoE. <h3>Conclusions:</h3> The correlations of DWI with different PESs have their distinctive characteristics. The DWI of inferior M2 as well as large infarcts and multiple cortical infarcts were associated with pAf, that of SCI with PxE and MSS with AoE. The characteristic histopathology and hydrodynamic mechanism of thrombi may determine DWI. <b>Disclosure:</b> Yasumasa Yamamoto has nothing to disclose.

Delayed CTP-Derived Deep Venous Outflow: A Novel Predictor of Striatocapsular Infarction after M1 Thrombectomy.

Isolated striatocapsular infarction occurs commonly in patients with ischemic stroke following M1 thrombectomy. We aimed to explore the correlation between CTP-derived parameters of deep venous outflow at presentation and subsequent striatocapsular infarction in a retrospective cohort of such patients. TTP and peak enhancement were measured on CTP-derived time-attenuation curves of the internal cerebral and thalamostriate veins bilaterally. The difference in TTP (ΔTTP) and the relative decrease in venous enhancement between the ischemic and normal sides were calculated. NCCT performed 24 (SD, 12) hours postthrombectomy was used to determine tissue fate in the caudate head, caudate body, lentiform nucleus, and internal capsule. Striatocapsular ischemia (striatocapsular infarction-positive) was defined as infarction and striatocapsular injury as either infarction, contrast enhancement, or hemorrhagic transformation in ≥1 of these regions. A striatocapsular ischemia score was calculated (0 = no ischemic region, 1 = 1 ischemic region, 2 = ≥2 ischemic regions). One hundred sixteen patients were included in the analysis. Sixty-one patients had striatocapsular infarction (striatocapsular infarction-positive). The mean thalamostriate ΔTTP was 1.95 (SD, 1.9) seconds for patients positive for striatocapsular infarction and 0.79 (SD, 2.1) for patients negative for it (P = .010). Results were similar for striatocapsular injury. The mean thalamostriate ΔTTP was 0.79 (SD, 2.1), 1.68 (SD, 1.4), and 2.05 (SD, 2) for striatocapsular infarction scores of 0, 1, and 2, respectively (P = .030). CTP-derived thalamostriate ΔTTP is an excellent surrogate marker for striatocapsular infarction in patients post-M1 thrombectomy. The novel approach of extracting venous outflow parameters from CTP has numerous potential applications and should be further explored.

Neuronal Alterations in Secondary Thalamic Degeneration Due to Cerebral Infarction: A 11C-Flumazenil Positron Emission Tomography Study.

Background:Studies using animal experiments have shown secondary neuronal degeneration in the thalamus after cerebral infarction. Neuroimaging studies in humans have revealed changes in imaging parameters in the thalamus, remote to the infarction. However, few studies have directly demonstrated neuronal changes in the thalamus in vivo. The purpose of this study was to determine whether secondary thalamic neuronal damage may manifest as a decrease in central benzodiazepine receptors in patients with cerebral infarction and internal carotid artery or middle cerebral artery disease.Methods:We retrospectively analyzed the data of 140 patients with unilateral cerebral infarction ipsilateral to internal carotid artery or middle cerebral artery disease. All patients had quantitative measurements of 11C-flumazenil binding potential (FMZ-BP), cerebral blood flow, and cerebral metabolic rate of oxygen using positron emission tomography in the chronic stage. Region of interest analysis was performed using NeuroFlexer—an automated region of interest analysis software using NEUROSTAT.Results:In the thalamus ipsilateral to the infarcts, the values of FMZ-BP, cerebral blood flow, and cerebral metabolic rate of oxygen were significantly lower than those in the contralateral thalamus. Significant correlations were found between the ipsilateral-to-contralateral ratio of FMZ-BP and the ipsilateral-to-contralateral ratio of cerebral blood flow or cerebral metabolic rate of oxygen in the thalamus. Patients with corona radiata infarcts and striatocapsular infarcts had significantly decreased ipsilateral-to-contralateral FMZ-BP ratio in the thalamus compared with those without. The ipsilateral-to-contralateral ratio of FMZ-BP in the thalamus was significantly correlated with the ipsilateral-to-contralateral cerebral metabolic rate of oxygen ratio in the frontal cortex and showed a significant negative correlation with the number of perseverative errors on the Wisconsin Card Sorting Test.Conclusions:Secondary thalamic neuronal damage may manifest as a decrease in central benzodiazepine receptors in patients with cerebral infarction and internal carotid artery or middle cerebral artery disease, which may be associated with frontal lobe dysfunction.

High-Resolution Intracranial Vessel Wall MRI Findings Among Different Middle Cerebral Artery Territory Infarction Types.

ObjectiveIntracranial atherosclerotic stroke occurs through various mechanisms, mainly by artery-to-artery embolism (AA) or branch occlusive disease (BOD). This study evaluated the spatial relationship between middle cerebral artery (MCA) plaques and perforating arteries among different MCA territory infarction types using vessel wall magnetic resonance imaging (VW-MRI).Materials and MethodsWe retrospectively enrolled patients with acute MCA infarction who underwent VW-MRI. Thirty-four patients were divided into three groups according to infarction pattern: 1) BOD, 2) both BOD and AA (BOD-AA), and 3) AA. To determine the factors related to BOD, the BOD and BOD-AA groups were combined into one group (with striatocapsular infarction [BOD+]) and compared with the AA group. To determine the factors related to AA, the BOD-AA and AA groups were combined into another group (with cortical infarction [AA+]) and compared with the BOD group. Plaque morphology and the spatial relationship between the perforating artery orifice and plaque were evaluated both quantitatively and qualitatively.ResultsThe plaque margin in the BOD+ group was closer to the perforating artery orifice than that in the AA group (p = 0.011), with less enhancing plaque (p = 0.030). In the BOD group, plaques were mainly located on the dorsal (41.2%) and superior (41.2%) sides where the perforating arteries mainly arose. No patient in the AA group had overlapping plaques with perforating arteries at the cross-section where the perforator arose. Perforating arteries associated with culprit plaques were most frequently located in the middle two-thirds of the M1 segment (41.4%). The AA+ group had more stenosis (%) than the BOD group (39.73 ± 24.52 vs. 14.42 ± 20.96; p = 0.003).ConclusionThe spatial relationship between the perforating artery orifice and plaque varied among different types of MCA territory infarctions. In patients with BOD, the plaque margin was closer and blocked the perforating artery orifice, and stenosis degree and enhancement were less than those in patients with AA.

External Validation of the WORSEN Score for Prediction the Deterioration of Acute Ischemic Stroke in a Chinese Population.

Background: Early neurological deterioration (END) has been recognized as a serious neurological complication after acute ischemic stroke. However, to date, the WORSEN score was the only one scoring system specifically developed to detect END events in acute ischemic stroke patients. The purpose of this study was to investigate the WORSEN score's utility in China, and to determine the potential predictors of END in acute stroke patients.Methods: Consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Aerospace Center Hospital between March 2015 to February 2017 were recruited into the study's cohort and divided into two groups: patients with and without END. END was defined as either an increase in two or more NIHSS points, an increment of at least one point in motor power or a description of fluctuating of clinical symptoms in medical reports during the first 7 days after admission. Severe END was defined as an increase of NIHSS ≥ 4 points from baseline during the first 7 days after admission.Results: Three hundred fifty four patients with acute ischemic stroke were enrolled in the present study and 67.5% were male. END occurred in 90 of these patients and severe END occurred in 55 of these patients. Logistic regression analysis showed that an initial NIHSS score ≥8, diameter of infarction, striatocapsular infarction, and TOAST type of large arterial atherosclerosis were independent predictors for END. The area under the ROC curve (AUC) of the WORSEN score for the prediction of END was 0.80 (95%CI 0.75–0.84), with a sensitivity of 62.22%, a specificity of 88.26%, positive predictive values of 64.37% and negative predictive values of 87.27%. Meanwhile, the AUC of the WORSEN score for the prediction of severe END was 0.82 (95%CI 0.78–0.86), with a sensitivity of 70.91%, specificity of 83.95%, positive predictive values of 44.83% and negative predictive values of 94.01%.Conclusion: END is a relatively common neurological complication in patients with acute ischemic stroke. Our findings showed that the WORSEN score had a good predictive value for identifying patients with END in a Chinese population. Moving forward, multi-center studies are required for further validations

Abstract TP85: The Characteristics of Diffusion Weighted Image Patterns in Different Potential Embolic Source

Introduction: Few studies have focused on the characteristics of diffusion weighted image (DWI) pattern in different embolic stroke. Hypothesis: Studying the DWI pattern in patients with embolic stroke of determined source may help presume the cause of ESUS. Methods: From a prospective registry of 1,764 consecutive patients with acute ischemic strokes , we selected 422 patients with embolic stroke of determined source comprising of 4 groups as follows. 1: continuous atrial fibrillation (cAf) (n=232), 2: paroxysmal Af (pAf) (n=99), 3: paradoxical embolism associated with the foramen ovale (PXE) (n=48) and 4: aortogenic embolism associated with aortic atheroma (≥4mm, ulcer or mobile) (AoE) (n=56). The DWI patterns were classified as follows. First, cortical infarcts were classified according to the affected area of middle cerebral artery (MCA) segments such as M1: the horizontal segment, M2: after the bifurcation segments within the Sylvian fissure and M4: terminal cortical branch. Among patients with M1, pure striatocapsular infarction (SCI) was identified. Moreover, patients with the M2 and the M4 were divided into 2 groups including parietal ascending branches and temporal descending branches. Second, cortical and subcortical small multiple infarcts (&lt;20mm) (sMI) were identified. Finally, infarcts in the anterior cerebral artery (AC) and the posterior circulation (PC) were identified. Results: The distribution of the DWI patterns in the 4 groups (cAf: pAf: PXE: AoE, %) are as follows: M1 (n=100) (76.0: 17.0: 7.0: 0), M2 (n=118) (59.3: 30.5: 7.6: 2.5), M4 (n=50) (50.0: 26.0: 18.0: 6.0), SCI (n=20) (2.1: 4.0: 14.5: 0), sMI (n=49) (18.3: 16.3: 18.3: 46.9), AC (n=13) (46.1: 46.1: 0: 7.6), and PC (n=92) (50.0: 20.6: 15.2: 14.1). Among 162 patients with M2 and M4 infarction, there were 57 involvements of descending branches (35.1%), comprising of 38 patients (41.7%) in cAf, 17 (34.6) in pAf, 1 (6.2) in PXE and 1(7.4) in AoE. Conclusions: Infarct sized was large in the Af groups. The involvement of inferior division of the MCA was exclusively found in the Af groups. The SCI was most prevalent in the PX. Multiple small scattered pattern was characteristically found in the AoE. The different DWI patterns relatively well associated with different embolic source.

Striatocapsular infarcts following mechanical thrombectomy

Striatocapsular infarcts following mechanical thrombectomy

Network change in the ipsilesional cerebellum is correlated with motor recovery following unilateral pontine infarction.

Patients with acute pontine infarcts generally have good short-term motor outcomes; however, the mechanisms underlying this recovery of function remain unclear. Twenty well-recovered patients with acute pontine infarcts and 20 well-recovered patients with acute striato-capsular infarcts were recruited. Fugl-Meyer assessment and resting-state functional magnetic resonance imaging were performed 1, 4 and 12weeks after onset. Patients were further assigned to better and worse recovery subgroups according to the degree of motor recovery at the twelfth week after stroke. Voxel-wise degree centrality (DC)-behavior correlation analysis was used to identify brain regions related to changes in motor function within 12weeks after stroke. A significant correlation was found between DC and Fugl-Meyer scores within 12weeks in the ipsilesional cerebellar crus I and crus II in patients with pontine infarction and in the ipsilesional middle temporal gyrus in patients with striato-capsular infarction (all P<0.001, AlphaSim corrected). The mean DC in these areas was higher both in the better and worse recovery subgroups at the fourth than at the first week (all P<0.05). In addition, the mean DC values in these areas were higher in patients with better recovery at the twelfth than at the first week (P<0.05), but such change was not found in patients with worse recovery. These results indicate that network changes in the ipsilesional cerebellum are correlated with motor recovery following pontine infarction. Motor recovery mechanisms may vary between pontine and striato-capsular infarcts, according to lesion location.

Vessel Wall Magnetic Resonance Imaging in a Case of Post-traumatic Multifocal Striatocapsular Hemorrhagic Infarction

Post-traumatic striatocapsular infarction is extremely rare and has been described only within the vascular territory of the perforating arteries originating from the middle cerebral artery (MCA). We recently encountered a patient presenting with unilateral multifocal striatocapsular hemorrhagic infarctions following mild head injury. This 25-year-old female was admitted to our trauma center after a motorcycle accident. Initial brain computed tomography and magnetic resonance (MR) imaging showed multifocal acute hemorrhagic infarctions with a clustering in the right caudate head, anterior limb of internal capsule, and globus pallidus. MR angiography and digital subtraction angiography showed suspicious luminal irregularities of the lenticulostriate arteries of the right MCA. Vessel wall MR images (VWI) did neither indicate intramural hematoma nor wall enhancement in the right MCA, suggesting dissection. However, VWI showed the passages of each lenticulostriate artery supplying each infarction site. Therefore, based on both conventional images and VWI, we postulate that this patient’s post-traumatic multifocal striatocapsular hemorrhagic infarctions were caused by damage to multiple lenticulostriate arteries.

Influence of mechanical thrombectomy on the incidence of isolated striatocapsular infarction and a description of its clinical characteristics

The great vulnerability of the striatocapsular region to ischaemia means that mechanical thrombectomy has its limitations in occlusions of large-calibre vessels when it comes to preventing the striatocapsular region from undergoing infarction. To analyse the effect of endovascular treatment on the incidence of isolated striatocapsular infarction (iSCI) and to describe its clinical characteristics. We conducted a retrospective study to analyse the incidence of iSCI following treatment of cerebral reperfusion. The baseline and clinical characteristics of the patients identified with iSCI and the incidence of iSCI is compared between two groups according to the availability of mechanical thrombectomy: one (pre-thrombectomy group) that received intravenous fibrinolysis as the only treatment for cerebral reperfusion available in that moment; and another (post-thrombectomy group) that received a mechanical thrombectomy with or without intravenous fibrinolysis. Of the 390 patients who received reperfusion, 8.2% had iSCI. Of the 135 patients treated with intravenous fibrinolysis, 4.4% (n = 6) developed iSCI (pre-thrombectomy group), and of the 255 patients treated in the post-thrombectomy group, iSCI was observed in 10.2%. The statistical analysis of the incidence of iSCI between the two groups showed significant differences (p = 0.034). A sensory-motor clinical picture was the most frequent among the patients with iSCI (63.33%), with a frequency of cortical symptoms of 55.17%. According to the data, there has been an increase in the incidence of iSCI in our setting following the establishment of mechanical thrombectomy.

Blood Oxygenation Level-Dependent Functional Magnetic Resonance Imaging in Early Days: Correlation between Passive Activation and Motor Recovery After Unilateral Striatocapsular Cerebral Infarction

This study aimed to investigate the correlation between the functional magnetic resonance imaging (fMRI) pattern and the motor function recovery of an affected limb during the passive movement of the affected limb at an early stage of the striatocapsular infarction (SCI). A total of 17 patients with an acute stage of SCI and 3 healthy volunteers as controls were included in this study. fMRI scans of passive movement were performed on the affected limbs of stroke patients within 1 week of onset. Follow-ups were carried out for the motor functions of the affected limbs (before fMRI scan, 1 month, and 3 months after the scan). The control group showed that the activation was mainly located in the contralateral sensorimotor cortex (SMC) and the bilateral supplementary motor area (SMA). The fMRI scan region of interest for stroke patients can be divided into 3 types: type I includes mainly the affected side, bilateral SMC, and SMA with activation; type II includes SMC on the affected side and SMA with activation; type III includes only SMC on the affected side or M1 with activation. The recovery of type I patients was better and faster, while the recovery of type II patients was better but slower, but recovery of type III patients was poorer and slower. Multiple cortical activation patterns were noted during the passive movement of the affected limbs at an early stage of SCI, and a correlation was found between the different activation patterns and the clinical prognosis of patients.

Isolated Striatocapsular Infarcts after Endovascular Treatment of Acute Proximal Middle Cerebral Artery Occlusions: Prevalence, Enabling Factors, and Clinical Outcome.

Striatocapsular infarcts (SCIs) are defined as large subcortical infarcts involving the territory of more than one lenticulostriate artery. SCI without concomitant ischemia in the more distal middle cerebral artery (MCA) territory [isolated SCI (iSCI)] has been described as a rare infarct pattern. The purpose of this study was to assess the prevalence of iSCI in patients treated with endovascular thrombectomy (ET), to evaluate baseline and procedural parameters associated with this condition, and to describe the clinical course of iSCI patients. A retrospective analysis of 206 consecutive patients with an isolated MCA occlusion involving the lenticulostriate arteries and treated with ET was performed. Baseline patient and procedural characteristics and ischemic involvement of the striatocapsular and distal MCA territory [iSCI, as opposed to non-isolated SCI (niSCI)] were analyzed using multivariate logistic regression models. Prevalence of iSCI was assessed, and clinical course was determined with the rates of substantial neurological improvement and good functional short- and mid-term outcome (discharge/day 90 Modified Rankin Scale ≤2). iSCI was detected in 53 patients (25.7%), and niSCI was detected in 153 patients (74.3%). Successful reperfusion [thrombolysis in cerebral infarction (TICI) 2b/3] [adjusted odds ration (aOR) 8.730, 95% confidence interval (95% CI) 1.069-71.308] and good collaterals (aOR 2.100, 95% CI 1.119-3.944) were associated with iSCI. In successfully reperfused patients, TICI 3 was found to be an additional factor associated with iSCI (aOR 5.282, 1.759-15.859). Patients with iSCI had higher rates of substantial neurological improvement (71.7 vs. 37.9%, p < 0.001) and higher rates of good functional short- and mid-term outcome (58.3 vs. 23.7%, p < 0.001 and 71.4 vs. 41.7%, p < 0.001). However, while iSCI patients, in general, had a more favorable outcome, considerable heterogeneity in outcome was observed. High rates of successful reperfusion (TICI 2b/3) and in particular, complete reperfusion (TICI 3) are associated with iSCIs. The high prevalence of iSCI in successfully reperfused patients with good collaterals corroborates previous concepts of iSCI pathogenesis. iSCI, once considered a rare pattern of cerebral ischemia, is likely to become more prevalent with increases in endovascular stroke therapy. This may have implications for patient rehabilitation and pathophysiological analyses of ischemic damage confined to subcortical regions of the MCA territory.

Differentiation of Deep Subcortical Infarction Using High-Resolution Vessel Wall MR Imaging of Middle Cerebral Artery.

ObjectiveTo evaluate the utility of high-resolution vessel wall imaging (HR-VWI) of middle cerebral artery (MCA), and to compare HR-VWI findings between striatocapsular infarction (SC-I) and lenticulostriate infarction (LS-I).Materials and MethodsThis retrospective study was approved by the Institutional Review Board, and informed consent was waived. From July 2009 to February 2012, 145 consecutive patients with deep subcortical infarctions (SC-I, n = 81; LS-I, n = 64) who underwent HR-VWI were included in this study. The degree of MCA stenosis and the characteristics of MCA plaque (presence, eccentricity, location, extent, T2-high signal intensity [T2-HSI], and plaque enhancement) were analyzed, and compared between SC-I and LS-I, using Fisher's exact test.ResultsStenosis was more severe in SC-I than in LS-I (p = 0.040). MCA plaque was more frequent in SC-I than in LS-I (p = 0.028), having larger plaque extent (p = 0.001), more T2-HSI (p = 0.001), and more plaque enhancement (p = 0.002). The eccentricity and location of the plaque showed no significant difference between the two groups.ConclusionBoth SC-I and LS-I have similar HR-VWI findings of the MCA plaque, but SC-I had more frequent, larger plaques with greater T2-HSI and enhancement. This suggests that HR-VWI may have a promising role in assisting the differentiation of underlying pathophysiological mechanism between SC-I and LS-I.

Distance to Thrombus in acute middle cerebral artery stroke predicts basal ganglia infarction after mechanical thrombectomy.

Background and PurposeThis study examines if involvement of the lenticulostriate arteries (LSAs) in MCA stroke and consecutive infarction of the basal ganglia can be predicted by the exact occlusion site, as determined in pre-interventional CT or MRI imaging.MethodsRetrospective analysis of 212 patients with acute isolated MCA occlusions treated with mechanical thrombectomy. The occlusion site was assessed using the Distance to Thrombus (DT). Affection of LSAs by the occlusion was determined by analysis of pre- and post-interventional DSA runs. Infarction of the striatocapsular region was evaluated in post-interventional imaging.ResultsDT showed a highly significant correlation with the affected LSA group (ρ = 0.747; P < 0.001). In a ROC analysis, DT could predict affection of the LSAs with an area under the curve (AUC) of 0.903. Additionally, DT could predict an infarction of the striatocapsular region with an AUC of 0.824. In a stepwise regression analysis for striatocapsular infarction including DT, age, time from symptom onset to recanalization and recanalization success, only DT proved to be an independent predictor.ConclusionIn MCA stroke, the exact site of the occlusion as measured by DT independently predicts the involvement of LSAs and subsequent striatocapsular infarction with high sensitivity and specificity.

Increased arterial pulsatility and progression of single subcortical infarction.

We investigated the association of clinical, laboratory, sonographic and imaging parameters, in the progression of single subcortical infarctions. Consecutive 169 patients with lacunar (n = 89) and striatocapsular infarctions (n = 80) in the middle cerebral artery (MCA) territory with nonstenotic MCAs were recruited and examined for stroke progression. The pulsatility index (PI) was measured by transcranial Doppler from ipsilateral M1. The striatocapsular infarction group exhibited more stroke progression. The patients with progressive lacunar infarctions had more diabetes, higher HbA1c levels, and higher initial National Institutes of Health Stroke Scale (NIHSS) scores, and the patients with progressive striatocapsular infarctions had more hypertension, higher cholesterol levels, and higher NIHSS scores. The MCA PI was higher in the lacunar infarction patients with progression (0.99 ± 0.19 vs. 0.90 ± 0.14, p = 0.048), while the striatocapsular infarction patients did not differ according to progression. From a multivariate analysis, higher MCA PI were independently associated with lacunar infarction progression (by 0.1 increase, OR 1.51; 95% CI 1.06-2.15; p = 0.024). Higher pulsatility was associated with progression in lacunar infarction. PI measured by transcranial Doppler sonography might reflect downstream arterial resistance and vascular/paravascular perfusion status and be a possible indicator of stroke progression. • Higher pulsatility index was observed in progression group of lacunar infarction patients. • Higher pulsatility index seemed to be associated with progression in lacunar infarction patients. • Differences in the factors associated with stroke progression suggest different underlying pathophysiologies.

Diffusion tensor imaging change in crus cerebri in striatocapsular infarction and correlation with upper extremity motor dysfunction.

There is limited information about the secondary changes in the pyramidal tract after some specific types of deep brain infarction including striatocapsular infarction. The aims of the current study were to investigate diffusion changes in the crus cerebri in patients with striatocapsular infarction using diffusion tensor imaging (DTI), and analyze the relationship between such changes and upper extremity motor dysfunction. Fifteen patients with acute onset of striatocapsular infarction and unilateral upper extremity motor dysfunction for the first time were studied prospectively. DTI was performed 2 weeks after disease onset, fractional anisotropy and mean diffusivity values of the bilateral crus cerebri were measured, the asymmetry indices of bilateral fractional anisotropy were calculated, and the relationship between the asymmetry index value and the Fugl-Meyer assessment score for the affected upper extremity function was evaluated. Two weeks after disease onset, the fractional anisotropy value of the affected crus cerebri was reduced significantly compared with that of the unaffected crus cerebri (0.69 vs. 0.77; p < 0.001); there was no significant difference between bilateral mean diffusivity values. After correction for infarct size (448.93 ± 227.67 mm(2)) there was a negative correlation between the asymmetry index value and the Fugl-Meyer assessment score of the affected upper extremity (r = -0.78, p = 0.001). DTI can detect the diffusion change in the crus cerebri in patients with striatocapsular infarction during the early stage of the disease and the integrity of the pyramidal tract in the crus cerebri is closely related to the motor function of the affected upper extremity.

Contralesional Spasticity of Conjugate Gaze in Striatocapsular Infarction

A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.