Single and multiple cerebral infarctions caused by atherosclerosis: morphology and pathogenesis

Cover Page


Cite item

Full Text

Abstract

In 139 cases of cerebral infarctions, caused by atherosclerosis, macro- and microscopic investigation of brain and its vascular system as well as heart examination were conducted. Infarctions were located in the anterior circulation in 68 cases, in the posterior circulation – in 36 cases, in both the anterior and posterior circulations – in 34 cases. Single extensive, large or medium cerebral infarction was found in 45 cases. In 93 cases there were multiple infarcts, located in the vertebrobasilar, carotid or both arterial territories. Infarctions in these cases were mainly small and medium. Number of cases with single and multiple infarcts in the anterior circulation were nearly the same, while infarcts in the posterior circulation were predominantly multiple. Main causes of either single or multiple infarctions in anterior circulation were obstructive atherothrombosis and cardiogenic thromboembolism, infarctions in posterior circulation were evoked by tandem atherostenosis and obstructive atherothrombosis of the brain arteries. It has been found that multiple infarctions within the one arterial territory mainly have the same mechanism of their occurrence. Infarctions of different subtypes were found more frequently when located in both the anterior and posterior circulations. The most frequent combination regardless of infarctions localization was combination of acute atherothrombotic infarct and old hemodynamic infarcts of smaller size.

 
 

About the authors

Anna N. Evdokimenko

Research Center of Neurology

Email: evdokimenko@neurology.ru
Россия, Moscow

Tatiana S. Gulevskaya

Research Center of Neurology

Author for correspondence.
Email: evdokimenko@neurology.ru
Россия, Moscow

References

  1. Болотова Т.А., Ануфриев П.Л. Критерии диагностики ишемических инсультов разных патогенетических подтипов у больных с атеросклерозом и артериальной гипертонией. Анн. клин. эксперимент. неврол. 2009; 4: 4–10.
  2. Верещагин Н.В. Патология вертебрально-базилярной системы и нарушения мозгового кровообращения. М.: Медицина, 1980.
  3. Верещагин Н.В., Моргунов В.А., Гулевская Т.С. Патология головного мозга при атеросклерозе и артериальной гипертонии. М.: Медицина, 1997.
  4. Гулевская Т.С., Моргунов В.А. Патологическая анатомия нарушений мозгового кровообращения при атеросклерозе и артериальной гипертонии. М.: Медицина, 2009.
  5. Гулевская Т.С., Моргунов В.А., Чайковская Т.С. Повторные инфаркты головного мозга при атеросклерозе и артериальной гипертонии. Архив патол. 2003; 4: 21–28.
  6. Гусев Е.И., Скворцова В.И., Стаховская Л.В. Эпидемиология в России. Инсульт. Прилож. к жур. неврол. и психиатр. 2003; 8: 4–9.
  7. Очерки ангионеврологии. Под ред. чл.-корр. РАМН З.А. Суслиной. М.: Атмосфера, 2005; 82–85.
  8. Adams H., Bendixen B., Kappelle L. et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke 1993; 24: 35–41.
  9. Altieri M., Metz R.J., Muller C. et al. Multiple brain infarcts: clinical and neuroimaging patterns using diffusion-weighted magnetic resonance. Eur. Neurol. 1999; 42: 76–82.
  10. Ay H., Furie K., Singhal A. et al. An evidence-based causative classification system for acute ischemic stroke. Ann. Neurol. 2005; 58: 688–697.
  11. Bamford J, Sandercock P, Dennis M. et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991 Jun 22; 337 (8756): 1521–1526.
  12. Bang O.Y., Heo J.H., Kim J.Y. et al. Middle cerebral artery stenosis is a major clinical determinant in striatocapsular small, deep infarction. Arch. Neurol. 2002; 2: 259–263.
  13. Bassetti C., Bogousslavsky J., Barth A., Regli F. Isolated infarcts of the pons. Neurology 1996; 1: 165–175.
  14. Bejot Y., Caillier M., Ben Salem D. et al. Ischaemic stroke subtypes and associated risk factors: a French population based study. J. Neurol. Neurosurg. Psychiatry 2008; 79: 1344–1348.
  15. Bogousslavsky J, Bernasconi А., Kumral Е. Acute Multiple Infarction Involving the Anterior Circulation. Arch. Neurol. 1996; 53 (1): 50–57.
  16. Bogousslavsky J. Double infarction in one cerebral hemisphere. Ann. Neurol. 1991; 30: 12–18.
  17. Bogousslavsky J., Regli F. Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Clinical and etiologic patterns. Arch. Neurol. 1990; 2: 144–150.
  18. Bogousslavsky J., Van Melle G., Regli F. Middle cerebral artery pial territory infarcts: a study of the Lausanne Stroke Registry. Ann. Neurol. 1989; 6: 555–560.
  19. Caplan L.R., Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch. Neurol. 1998; 11: 1475–1482
  20. Chodosh E.H., Foulkes M.A., Kase C.S. et al. Silent stroke in the NINCDS Stroke Data Bank. Neurology 1988; 38: 1674–1679.
  21. Goldstein L., Jones M., Matchar D. et al. Improving the reliability of stroke subgroup classification using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke 2001; 32: 1091–1097.
  22. Kolominsky-Rabas P., Weber M., Gefeller O. et al. Epidemiology of ischemic stroke subtypes according to TOAST criteria. Stroke 2001; 32: 2735–2740.
  23. Landau W., Nassief A. Time to burn the TOAST. Stroke 2005; 36: 902–904.
  24. Lee D.K., Kim J.S., Kwon S.U. et al. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease: early diffusion- weighted imaging study. Stroke 2005; 12: 2583–2588.
  25. Lee J.H., Han S.J., Yun Y.H. et al. Posterior circulation ischemic stroke in Korean population. Eur J Neurol. 2006; 7: 742–748.
  26. Lovett J.K., Coull A.J., Rothwell P.M. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology 2004; 4: 569–573.
  27. Milandre L., Brosset C., Botti G., Khalil R. Etude de 82 infarctus du territoire des arteres cerebrales posterieures. Rev. Neurol. (Paris). 1994; 150: 133–141.
  28. Paciaroni M., Silvestrelli G., Caso V. et al. Neurovascular territory involved in different etiological subtypes of ischemic stroke in the Perugia Stroke Registry. Eur. J. Neurol. 2003; 4: 361–365.
  29. Ricci S., Celani M.G., La Rosa F. et al. Silent brain infarctions in patients with first-ever stroke: a community-based study in Umbria, Italy. Stroke 1993; 24: 647–651.
  30. Roh J.K., Kang D.W., Lee S.H. et al. Significance of acute multiple brain infarction on diffusion-weighted imaging. Stroke 2000; 3: 688–694.
  31. Shin D.H., Lee P.H., Bang O.Y. Mechanisms of recurrence in subtypes of ischemic stroke: a hospital-based follow-up study. Arch Neurol. 2005; 8: 1232–1237.
  32. Vuilleumier P., Bogousslavsky J., Regli F. Infarction of the lower brainstem. Clinical, aetiological and MRI-topographical correlations. Brain. 1995; 118: 1013–1025.
  33. Yamamoto Н., Bogousslavsky J. Mechanisms of second and further strokes. J. Neurol. Neurosurg Psychiatry. 1998; 64: 771–776.
  34. Yip P., Jeng J., Lee T. et al. Subtypes of ischemic stroke. A hospitalbased stroke registry in Taiwan (SCAN-IV). Stroke

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2011 Evdokimenko A.N., Gulevskaja T.S.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies