Abstract
We sought to determine the clinical pictures, topography and pathogenesis of patients
with unilateral single or multiple corona radiata infarcts. We defined corona radiata
ischemic stroke if the patient had a focal neurological deficit and a relevant non-hemorrhagic
infarction confined to the vascular territory of a long medullary artery proved by
CT and MRI with contrast. We compared risk factors and clinical feature between subtypes
of corona radiata infarcts. The study sample represents 1,2% of the patients (68/5500)
with first-ever stroke in our Registry, including ischemic and hemorrhagic strokes.
There were 37 patients (54%) with single infarct presenting 17 different complete
or partial sensory-motor symptoms with dysarthria; 14 patients (21%) with unilateral
multiple infarcts in one hemisphere had oftenly complete sensorimotor deficits with
some neuropsychological impairment; among 17 patients (25%) with multiple infarcts
in both hemisphere, one half had bilateral motor and sensory symptoms, and neuropsychological
deficits, visual field defects were uncommon. Seventeen patients (25%) had dysarthria,
which was no localizing value. Hypertension was the most frequent vascular risk factor
in 62% of patients, smoking in 28%, diabetes mellitus in 26%, hypercholesterolemia
in 9%, and atrial fibrillation in 7%. The main cause of corona radiata infarcts was
small-artery disease with long-standing hypertension in 40 patients (59%), large-artery
disease in 19%, cardioembolism in 12%. Most of the patients (88%) had leukoaraiosis,
and patients with bilateral multiple infarcts, leukoaraiosis was more frequent than
in those with unilateral single infarct (P =.016; <.05). Despite clinical similarity to that found in superficial and deep infarcts,
incomplete motor and sensory symptoms and MRI allows to delineate simultaneous uni-
or multiple infarcts in the corona radiata. After an acute and immediate onset, outcome
at 6 months of stroke onset is in general benign except those with bilateral infarcts.
The coexistence of small-artery disease with leukoaraiosis suggest similar vascular
risk factors and physiopathological mechanism. Copyright © 2003 by National Stroke
Association
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The human periventricular arterial blood supply and the anatomy of cerebral infarctions.Eur Neurol. 1971; 5: 321-334
- Deep perforators from the carotid system: template of the vascular territories.Arch Neurol. 1990; 47: 1097-1100
- The course and territories of cerebral small arteries.Adv Neurol. 1993; 62: 11-41
- Arterial territories of human brain.in: Stroke Syndromes. Cambridge University Press, Cambridge, UK2001: 371-404
- Borderzone infarction distal to internal carotid artery occlusion.Ann Neurol. 1986; 20: 346-350
- Unilateral watershed cerebral infarcts.Neurology. 1986; 36: 373-377
- Internal border zone infarction following acute middle cerebral artery occlusion.Neurology. 1990; 40: 1196-1198
- Clinical features, pathogenesis, and computed tomographic characteristics of internal watershed infarction.Stroke. 1993; 24: 1925-1932
- Leuko-araiosis.Arch Neurol. 1987; 44: 21-23
- Leuko-araiosis on MRI and speed of mental processing.Arch Neurol. 1990; 47: 151-156
- Hemorrhagic white matter infarction in three critically ill patients.Hum Pathol. 1977; 8: 121-132
- Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study.Neurology. 1994; 44: 1246-1252
- White matter medullary infarcts: acute subcortical infarction in the centrum ovale.Cerebrovasc Dis. 1998; 8: 289-295
- MRI of ataxic hemiparesis localized to the corona radiata.Stroke. 1989; 20: 1571-1573
- Centrum ovale infarcts; subcortical infarction in the superficial territory of the middle cerebral artery.Neurology. 1992; 42: 1992-1998
- Pure dysarthria, isolated facial paresis, or dysarthria-facial paresis syndrome.Stroke. 1994; 25: 1994-1998
- Small infarcts in the centrum ovale: predisposing factors.Cerebrovasc Dis. 1994; 4: 83-87
- The Ege stroke registry: A hospital-based study in the Aegean Region, İzmir, Turkey.Cerebrovasc Dis. 1998; 8: 278-288
- Features of the cerebral vascular pattern that predict vulnerability to perfusion or oxygenation deficiency: An anatomic study.AJNR. 1990; 11: 431-439
- Pathogenesis of Binswanger chronic progressive subcortical encephalopathy.Neurology. 1980; 30: 920-928
- Pure motor stroke: A reappraisal.Neurology. 1992; 42: 789-798
- Isolated sensorimotor stroke: a reevaluation of clinical, topographic and etiological patterns.Cerebrovasc Dis. 1993; 3: 357-363
- Sensorimotor stroke; clinical features, MRI findings, and cardiac and vascular concomitants in 32 patients.Acta Neurol Scand. 1998; 97: 93-98
- Parkinson syndromes due to various specific causes.in: Handbook of Clinical Neurology. vol 6. Elsevier, Amsterdam, North Holland1968: 227-247
- Parkinsonism in patients with cerebral infarcts: Clin Neurol Neurosurg. 1980; 82-3: 177-185
- Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions.Mov Disord. 1998; 13: 89-95
- Small dep cerebral infarcts associated with occlusive internal caroid artery disease: a hemodynamic phenomenon?.Arch Neurol. 1990; 47: 953-957
- Frequency and degree of carotid stenosis in small centrum ovale infarcts as compared to lacunar infarcts.Cerebrovasc Dis. 1997; 7: 138-143
Article info
Publication history
Accepted:
December 6,
2002
Received:
June 21,
2002
Footnotes
*Address reprint requests to: Prof. Emre Kumral, MD, Stroke Unit, Department of Neurology, Ege University, Bornova, Izmir, 35100, Turkey. E-mail: [email protected]
**1052-3057/03/1202-0001$30.00/0
Identification
Copyright
© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
