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Are multiple acute small subcortical infarctions caused by embolic mechanisms?

Department of Clinical Neuroscience, Lund University Hospital, Sweden

Correspondence to:
Correspondence to:
Dr B Norrving
Department of Neurology, Lund University Hospital, Lund S-22185, Sweden; bo.norrving@neurol.lu.se

Keywords: Cerebral infarction; diffusion weighted MRI; lacunar stroke; stroke

The first 150 words of the full text of this article appear below.

In this issue the paper by Chowdhury et al (see page 1416)¹ is an important addition to the list of recent publications that challenge traditional concepts on the mechanisms of acute ischaemic stroke. According to conventional teaching, an acute ischaemic stroke is characterised by infarction confined to a single localised (focal) region of the brain. However, new neuroimaging techniques—in particular diffusion weighted magnetic resonance imaging (dw-MRI)—have modified this view.

In a recent study,² scattered lesions in one vascular territory or multiple lesions in multiple vascular territories were actually more common than single lesions. Although dw-MRI is very sensitive in the ultra-early detection of cerebral ischaemia, it should be recognised that the dw-MRI lesions are not equivalent with infarction. Dw-MRI abnormalities may be reversible if the level of ischaemia is mild, or if early reperfusion occurs—for example, by means of thrombolytic therapy. Nevertheless, dw-MRI findings may . . . [Full text of this article]

Relevant Article

Are multiple acute small subcortical infarctions caused by embolic mechanisms?

D Chowdhury, J M Wardlaw, and M S Dennis
J. Neurol. Neurosurg. Psychiatry 2004 75: 1416-1420. [Abstract] [Full Text] [PDF]