Unilateral lenticular infarcts: radiological and clinical syndromes, aetiology, and prognosis

Abstract

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...

Clinical Spectrum of Movement Disorders after Stroke in Childhood and Adulthood

“…Hemidystonia is more often induced by a stroke in the striatopallidal complex, thalamic, brainstem and cerebellum, as we have reported in 20 cases [5]. Lesions in the striatopallidal complex could interrupt the cortico-striato-pallido-thalamo-cortical loop (both the direct and indirect pathways) leading to increased thalamocortical drive and overactivity in primary and accessory motor areas [13].…”

“…Hence, aphasia is uncommon until language is acquired. In contrast, epilepsy is more frequent than in adults (30 vs. 15%) as are movement disorders [1,2,3,4,5]. …”

“…According to data from hospital-based studies, the prevalence during and after acute stroke varies from 1.1 [7] to 3.9% [8]. In our experience based on the population-based Stroke Registry of Dijon, France [1,2,3,4,5,10], the prevalence of movement disorders in the acute stage of stroke is nearly 3.5%. We observed in a decreasing order in adulthood, chorea, limb shaking syndrome and hemiballism, whereas in childhood, dystonia was the most frequent movement disorder observed in the acute stage of stroke.…”

“…Many different types of hyperkinetic and hypokinetic movement disorders have been described during or after an acute ischemic or hemorrhagic stroke (table 1) [1,2,3,4,5,6,7,8,9]. They occur in men and women equally, and the age at onset varies depending on the movement disorders considered [7,8].…”

Automated injury segmentation to assist in the treatment of children with cerebral palsy

“…The association between these anatomies with language comprehension has been demonstrated in the literature [Giroud et al, 1997;Watkins et al, 2002]. Gender was observed to be a factor for both scores of executive function, indicating that females performed better than males in these tasks within the age range of 5-17, which was expected.…”