Small Centrum Ovale Infarcts on Diffusion-Weighted Magnetic Resonance Imaging

Abstract

Background and Purpose-A small centrum ovale infarct (SCOI), caused by occlusion of the white matter medullary arteries, is often equated with a lacunar infarct. We sought to clarify the clinical characteristics of a SCOI visualized by diffusion-weighted MRI (DWI) compared with those of a small basal ganglia infarct (SBGI). Methods-Patients with a SCOI (SCOI group; nϭ38) or SBGI (SBGI group; nϭ68) Յ15 mm in diameter on conventional MRI and DWI were selected from 582 consecutive patients with acute ischemic stroke. Sex, age, neurological symptoms, vascular risk factors, emboligenic heart disease, arterial occlusive disease in the ipsilateral carotid system, and recurrent stroke within the initial 30 days were compared between the 2 groups. Results-Only 47% of SCOIs but 87% of SBGIs could be identified with the use of conventional MRI, whereas DWI could detect them all. Age, sex, and vascular risk factors were not significantly different between the 2 groups. The SCOI group had more frequently an abrupt onset of symptoms (63% versus 26%; Pϭ0.0002), emboligenic heart diseases (34% versus 12%; Pϭ0.0054), occlusive carotid and/or middle cerebral artery diseases (53% versus 19%; Pϭ0.0004), and recurrent stroke (13% versus 1%; Pϭ0.0216) but less frequently a classic lacunar syndrome (50% versus 81%; Pϭ0.0009) than the SBGI group. On a multivariate analysis, both arterial and heart diseases were independently associated with the SCOI group. Conclusions-Symptomatic SCOIs detected by DWI may be associated with large-vessel and heart diseases and should be distinguished from lacunar infarcts.

Long Insular Artery Infarction: Characteristics of a Previously Unrecognized Entity

“…In a previous study investigating the clinical differences between WMMA and LSA infarction, the incidence of nonlacunar syndromes was significantly higher in WMMA infarcts (observed in approximately half) than in LSA infarcts. 6 Most interesting, clinical symptoms of LIA infarction resemble those of the LSA infarction rather than WMMA infarction, though the LIAs are anatomically recognized as a subtype of the WMMA. This feature also suggests that LIA infarcts cannot be distinguished from LSA infarcts by clinical symptoms alone.…”

“…Most important, an embolic mechanism has also been suggested for WMMA infarction. [3][4][5][6] Because LIAs are a subtype of WMMA, the pathogenesis of the LIA infarction could be similar to that of the WMMA infarction. The size or shape of LIA and LSA infarcts corresponds with so-called lacunar infarction, for which stroke physicians often place a low priority for the evaluation of embolic sources and frequently recommend antiplatelet agents, because this pathology has been regarded as a small-vessel disease.…”

“…[1][2][3][4][5][6][7][8] Among the deep penetrating arteries, the lenticulostriate arteries (LSAs) arise from the M1 segment of the MCA and supply the lower part of the corona radiata. [7][8][9][10] The superficial penetrating arteries, namely the white matter medullary arteries (WMMAs), arise from the cortical branches of the MCA and feed the periventricular deep white matter.…”

“…[7][8][9][10] The superficial penetrating arteries, namely the white matter medullary arteries (WMMAs), arise from the cortical branches of the MCA and feed the periventricular deep white matter. [1][2][3][4][5][6] Several reports suggest that WMMA infarction should be distinguished from LSA infarction and treated differently because of their different clinical and etiologic backgrounds. [4][5][6] The long insular artery (LIA) is a unique supplier of the periventricular white matter.…”

“…[1][2][3][4][5][6] Several reports suggest that WMMA infarction should be distinguished from LSA infarction and treated differently because of their different clinical and etiologic backgrounds. [4][5][6] The long insular artery (LIA) is a unique supplier of the periventricular white matter. It is one of the medullary arteries in close vicinity to the territory of deep perforators.…”