Striatocapsular Infarction: Clinical Feature, Pathogenesis, and Radiologic Characteristic

ABSTRACT

Background and purpose: Striatocapsular infarction (SCI) has recently been described as a distinct type of stroke and forms an Important subgroup of sub-cortical infarction. The aims of this study were to define the clinical profile, pathogenesis and radiological features of the SCI. METHODS: Based on computed tomographic (CT) and magnetic resonance (MR) findings, 24 patients with SCI were selected from among 599 patients admitted consecutively to our Institute from January, 1993 to June, 1995 and reviewed with attention to clinical characteristics and radiological findings retrospectively. SCI defined as the following CT and MR imaging criteriathe area of infarction included the internal capsule and striatum, the maximum diameter of the lesion exceeded 20mm without cortical involvement Results: The study population consisted of 12 men and 12 women, aged 33 to 80 years. The most common clinical presentation was a stuttering progression of the motor weakness, sensory change and accompanying cortical dysfunction. Eight patients presented with a lacunar syndrome(3pure motor syndrome and 5sensory motor syndrome). The 13 patients had the sign of cortical dysfunction. Only one patients experienced TIA in ipsilateral carotid territory. Risk factors for atherosclerosis were hypertension in 10 (42%) patients, diabetes in 4(17%), smoking in 9(41%), and hypercholesterolemia in 2(8%). The presumed mechanism of stroke was large artery thrombosis in 15 (63%) patients (13 MCA, 4 ICA)definite cardioembolism in 6(25%), (arterial fibrillation in 5, myocardial infarction in 2) embolic infarction with tandem arterial pathology in1 Moyamoya disease in 1 undetermined cause in 1. Conclusions: We conclude that, SCI occurs mostly due to occlusive disease of cerebral large vessel and not due to a disseminated in situ occlusion of the long penetrating arteries as in lacunas. It is important because the different pathological mechanisms demand different therapeutic strategies.