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J Korean Neurol Assoc. 1999;17(4):459-465.
- The Importance of Middle Cerebral Artery Stenosis In Patients With A
Lacunar Infarction In The Carotid Artery Territory
Background : It is well known that a lacunar infarction may develop by an atherosclerosis of the large intracranial
arteries at the
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Oh Young Bang, M.D., Jeong Hoon Cho, M.D., Ji Hoe Heo, M.D., Dong Ik Kim, M.D.*
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Department of Neurology and Radiology* Yonsei University, College of Medicine, Seoul, Korea
- 경동맥 영역의 열공경색증 환자에서
중뇌동맥 협착의 중요성
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방오영, ·조정훈 ·허지회 ·김동익*
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연세대학교 의과대학 신경과학교실,진단방사선과학교실*
- Abstract
- Background
: It is well known that a lacunar infarction may develop by an atherosclerosis of the large intracranial
arteries at the site of the perforating arteries. However, their frequency, clinical, and radiological findings have rarely been
described. Methods : Carotid angiograpies were carried out in 26 Korean patients with lacunar infarctions in the carotid
arterial territory. They all had classical lacunar symptoms with a computed tomogram (CT) or a magnetic resonance image
(MRI) evidence of a small infarction. A transesophageal echocardiography (TEE) was carried out in fifteen patients when
either an angiography result was normal, the potential source of cardioembolism was suggested, or no other atherothrom-botic
causes of stroke were found. Tc-99m single positron emission computed tomograms (SPECT) were performed in
nine patients. We divided patients into two groups; one for patients with MCA occlusive lesion, and another for those
without it. The clinical and radiological features were compared between the two groups. Results : Twenty patients (77%)
demonstrated abnormal angiographic findings. Fourteen of them showed atherosclerotic changes in the proximal MCA at
the site of the orifice of the lenticulostriatal arteries, while another three showed stenosis in the intracranial portion of the
internal cerebral artery (ICA), and the other three in the extracranial ICA. Among six patients with normal angiograms, a
TEE demonstrated embolic sources of embolism in two patients. The temporal profile and findings of MRI and SPECT in
patients with MCA stenosis differed from those with ICA stenosis or normal angiograms. Unstable temporal profiles
exclusively occurred in patients with MCA stenosis. The most patients with conglomatory aggregations of the lacune in a
MRI showed MCA lesions. The SPECT findings were even more characteristic in that patients with MCA lesions showed
relatively large areas of decreased perfusion. Conclusions : The atherosclerotic diseases at the orifice of the lenticulostri-atal
arteries were the most common causes of lacunar infarctions in the carotid artery territory. They were clearly different
from those without MCA occlusive lesions in terms of preceding transient ishemic attacks, unstable temporal profiles, uni-lateral
multiple lacunes with conglomatory MRI findings, and widespread perfusion defects SPECT.
Keywords :
- 초록
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