Objectives-To analyse the clinical features induced by lenticular infarction found in 20 patients, and to analyse the radiological and clinical correlations. Methods-Eight women and 12 men, mean age 73 years, were included in this study, which was carried out from 1 January 1994 to 30 November 1996. They were characterised by the onset of a lenticular infarction, shown by CT and MRI. A complete neurological and neurocognitive examination, and photon emission computed tomography (SPECT), were performed in all the patients and there was a long clinical follow up. Results-Two distinct clinical syndromes were identified corresponding to the two anatomical areas of the lenticular nucleus: behavioural and cognitive disorders were associated with infarcts within the globus pallidus, whereas both motor disorders (dystonia) and cognitive disorders were associated with infarcts within the putamen. Outcome was excellent in all the patients for motor function, but slight cognitive disorders, problems with short term memory, and dysphasia persisted for several months. The size of the lesion did not explain these symptoms. By contrast, the slight reduction in cerebral blood flow found in the adjacent frontotemporal area may explain them by a deaVerentation or a diaschisis phenomenon. Conclusion-It is possible to identify the clinical symptoms of a single lesion in the pallidus nucleus and in the putaminal nucleus, in which behavioural, cognitive, and movements disorders are important. After an acute and spectacular onset, outcome is in general excellent. A disease of the small arteries must be involved. (J Neurol Neurosurg Psychiatry 1997;63:611-615) Keywords: infarction: lentiform nucleus: motor disorders: cognitive disorders A knowledge of the functions of the basal ganglia is important.The lesions that damage the human brain are rarely restricted to a single anatomical structure. Published case reports of lenticular infarction often include patients whose infarcts were not limited to the lenticular nucleus.1 However, modern imaging techniques such as CT and MRI are able to identify lesions restricted to the lenticular nucleus.We present the clinical findings, the radiological features, the aetiologies, and the long term prognosis of 20 patients with an isolated lenticular infarct established by CT and MRI.
MethodsWe studied all patients with an acute lenticular infarct-diagnosed by both CT and MRIwho were admitted to the neurology department between 1 January 1994 and 30 November 1996 (eight women and 12 men). We excluded patients with previous strokes or with associated infarcts in the internal capsule, the caudate nucleus, or the thalamus. All patients were studied by all of us and they had the same investigations including standard blood tests, ECG, transoesophageal echography (TEE), Doppler ultrasound, CT at day 1 and day 10, MRI at day 7, and SPECT at day 10.Brain CT and MRI were performed using orbitomeatal horizontal sequences and coronal sequences also for MRI. An ischaemic stroke was defined by a hypode...