Top

Neurological Sciences

Published in:

01-12-2020 | Dyslipidemia | Original Article

Cavitation of symptomatic acute single small subcortical infarctions

Authors: Xin Zhang, Yonggui Ge, Caihong Liang, Yujie Wang

Published in: Neurological Sciences | Issue 12/2020

Abstract

Background and purpose

To investigate cavitation of symptomatic acute single small subcortical infarctions (SSSI).

Methods

Acute SSSI were diagnosed with magnetic resonance (MR) diffusion-weighted imaging (DWI) combined with apparent diffusion coefficient (ADC) sequence on follow-up MR imaging. Cavitation of the acute SSSI was comprehensively viewed on FLAIR, T2-, and T1-weighted sequences.

Results

We enrolled 123 patients with acute SSSI. The follow-up median interval was 303 (125–390) days. The lesions of SSSI evolved into cavitation in 93 patients (75.6%), evolved into WMHs in nine patients (7.3%), and were no visible in 21 patients (17.1%). Cavitation was independently associated with larger infarct diameter on baseline DWI [odds ratio (OR), 1.250, 95% CI (1.078–1.451), P = 0.003], higher score of baseline old lacunar infarct [OR 3.44, 95% CI (1.49–7.91), P = 0.004], and lower rate of dyslipidemia [OR 0.30, 95% CI (0.10–0.76), P = 0.013].

Conclusion

Cavitation occurred more in the setting of small vessel diseased brain and less in the SSSI of possible atherosclerotic etiology. This suggested that the etiology of infarct was associated with cavitation after acute SSSI.

Potter GM, Doubal FN, Jackson CA, Chappell FM, Sudlow CL, Dennis MS, Wardlaw JM (2010) Counting cavitating lacunes underestimates the burden of lacunar infarction. Stroke 41:267–272. https://doi.org/10.1161/STROKEAHA.109.566307CrossRefPubMed

Koch S, McClendon MS, Bhatia R (2011) Imaging evolution of acute lacunar infarction. Neurology 77:1091–1095. https://doi.org/10.1212/WNL.0b013e31822e1470CrossRefPubMed

Moreau F, Patel S, Lauzon ML, McCreary CR, Goyal M, Frayne R, Demchuk AM, Coutts SB, Smith EE (2012) Cavitation after acute symptomatic lacunar stroke depends on time, location, and MRI sequence. Stroke 43:1837–1842. https://doi.org/10.1161/strokeaha.111.647859CrossRefPubMed

Loos CM, Staals J, Wardlaw JM et al (2012) Cavitation of deep lacunar infarcts in patients with first-ever lacunar stroke: a 2-year follow-up study with MR. Stroke 43:2245–2247. https://doi.org/10.1161/strokeaha.112.660076CrossRefPubMed

Okazaki S, Hornberger E, Griebe M, Gass A, Hennerici MG, Szabo K (2015) MRI characteristics of the evolution of Supratentorial recent small subcortical infarcts. Front Neurol 6:118. https://doi.org/10.3389/fneur.2015.00118CrossRefPubMedPubMedCentral

Zhang X, Ding L, Yang L et al (2016) Relationship between white matter hyperintensities penumbra and cavity formation. Med Sci Monit 22:41–49. https://doi.org/10.12659/msm.896324CrossRefPubMedPubMedCentral

Lee KJ, Jung H, Oh YS, Lim EY, Cho AH (2017) The fate of acute lacunar lesions in terms of shape and size. J Stroke Cerebrovasc Dis 26:1254–1257. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.01.017CrossRefPubMed

Kwon HS, Cho AH, Lee MH et al (2019) Evolution of acute lacunar lesions in terms of size and shape: a PICASSO sub-study. J Neurol 266:766–772. https://doi.org/10.1007/s00415-019-09201-7CrossRefPubMed

Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MMB (2003) Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 348:1215–1222. https://doi.org/10.1056/NEJMoa022066CrossRefPubMed

10.

Liem MK, van der Grond J, Haan J, van den Boom R, Ferrari MD, Knaap YM, Breuning MH, van Buchem MA, Middelkoop HAM, Lesnik Oberstein SAJ (2007) Lacunar infarcts are the main correlate with cognitive dysfunction in CADASIL. Stroke 38:923–928. https://doi.org/10.1161/01.STR.0000257968.24015.bfCrossRefPubMed

11.

van der Flier WM, van Straaten ECW, Barkhof F, Verdelho A, Madureira S, Leonardo Pantoni L et al (2005) Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke 36:2116–2120. https://doi.org/10.1161/01.str.0000179092.59909.42CrossRefPubMed

12.

King KS, Peshock RM, Warren MW, Alhilali L, Hulsey K, McColl R, Weiner MF, Ayers C, Whittemore A (2013) Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location. AJNR Am J Neuroradiol 34:797–801. https://doi.org/10.3174/ajnr.A3283

13.

Moody DM, Bell MA, Challa VR (1990) Features of the cerebral vascular pattern that predict vulnerability to perfusion or oxygenation deficiency: an anatomic study. AJNR Am J Neuroradiol 11:431–439PubMedPubMedCentral

14.

Falcao ALE, Reutens DC, Markus R, Koga M, Stephen J. Read, Henri Tochon-Danguy, John Sachinidis, David W. Howells, Geoffrey A. Donnan. The resistance to ischemia of white and gray matter after stroke. Ann Neurol 2004;56:695–701. doi. https://doi.org/10.1002/ana.20265

15.

Zhang XD, Yan YM, Tong F, Li CX, Jones B, Wang S, Meng YG, Muly EC, Kempf D, Howell L (2018) Progressive assessment of ischemic injury to white matter using diffusion tensor imaging: a preliminary study of a macaque model of stroke. Open Neuroimaging J 12:30–41. https://doi.org/10.2174/1874440001812010030CrossRef

16.

Brown WR, Thore CR (2011) Cerebral microvascular pathology in aging and neurodegeneration. Neuropathol Appl Neurobiol 37:56–74. https://doi.org/10.1111/j.1365-2990.2010.01139.xCrossRefPubMedPubMedCentral

17.

van Leijsen EMC, de Leeuw FE, Tuladhar AM (2017) Disease progression and regression in sporadic small vessel disease-insights from neuroimaging. Clin Sci (Lond) 131:1191–1206. https://doi.org/10.1042/CS20160384CrossRef

18.

Ye H, Wu X, Yan J, Wang J, Qiu J, Wang Y (2019) Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis. Neurol Sci 40:509–514. https://doi.org/10.1007/s10072-018-3683-9CrossRefPubMed

19.

Kim JS, Yoon Y (2013) Single subcortical infarction associated with parental arterial disease: important yet neglected sub-type of atherothrombotic stroke. Int J Stroke 8:197–203. https://doi.org/10.1111/j.1747-4949.2012.00816.xCrossRefPubMed

20.

Yoon Y, Lee DH, Kang DW, Kwon SU, Kim JS (2013) Single subcortical infarction and atherosclerotic plaques in the middle cerebral artery: high-resolution magnetic resonance imaging findings. Stroke 44:2462–2467. https://doi.org/10.1161/STROKEAHA.113.001467CrossRefPubMed

21.

Fisher CM (1991) Lacunar infarcts - a review. Cerebrovasc Dis 1:311–320. https://doi.org/10.1159/000108861CrossRef

22.

Wardlaw JW, Smith C, Dichgans M (2013) Mechanisms underlying sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol 12:483–497. https://doi.org/10.1016/S1474-4422(13)70060-7CrossRefPubMed

23.

Lam CK, Yoo T, Hiner B, Liu Z, Grutzendler J (2010) Embolus extravasation is an alternative mechanism for cerebral microvascular recanalization. Nature 465:478–482. https://doi.org/10.1038/nature09001CrossRefPubMedPubMedCentral

24.

Grutzendler J, Murikinati S, Hiner B, Ji L, Lam CK, Yoo T, Gupta S, Hafler BP, Adelman RA (2014) Angiophagy prevents early embolus washout but recanalizes microvessels through embolus extravasation. Sci Transl Med 6(226):226ra31. https://doi.org/10.1126/scitranslmed.3006585CrossRefPubMed

Title: Cavitation of symptomatic acute single small subcortical infarctions
Authors: Xin Zhang
Yonggui Ge
Caihong Liang
Yujie Wang
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keyword: Dyslipidemia
Published in: Neurological Sciences / Issue 12/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04509-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cavitation of symptomatic acute single small subcortical infarctions

Abstract

Background and purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2020

A novel SGCE variant is associated with myoclonus-dystonia with phenotypic variability

Anti-LGI1 encephalitis in a middle-aged woman who consumes cannabis oil

Electrodiagnostic accuracy in polyneuropathies: supervised learning algorithms as a tool for practitioners

Pearl and pitfalls in brain functional analysis by event-related potentials: a narrative review by the Italian Psychophysiology and Cognitive Neuroscience Society on methodological limits and clinical reliability—part II

Idiopathic (genetic) generalized epilepsies with absences: clinical and electrographic characteristics and seizure outcome

HLA and immunological features of SARS-CoV-2-induced Guillain-Barré syndrome