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Research paper
Cortical border-zone infarcts: clinical features, causes and outcome
  1. Claire Joinlambert1,
  2. Guillaume Saliou2,
  3. Constance Flamand-Roze1,
  4. Pascal Masnou1,
  5. Mariana Sarov1,
  6. Raphaelle Souillard2 3,
  7. Marie Saliou-Théaudin1,
  8. Thierry Guedj1,
  9. Patrick Assayag3,4,
  10. Denis Ducreux2,3,5,
  11. David Adams1,3,5,
  12. Christian Denier1,5
  1. 1Department of Neurology, Bicêtre Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
  2. 2Department of Neuroradiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
  3. 3PARIS XI - Sud University, Le Kremlin-Bicêtre, France
  4. 4Department of Cardiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
  5. 5INSERM U788, Le Kremlin-Bicêtre, France
  1. Correspondence to Dr Christian Denier, Department of Neurology, Hôpital de Bicêtre, Assistance Publique des Hôpitaux de Paris (AP-HP), 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France; christian.denier{at}bct.aphp.fr

Abstract

Objective To report the clinical features, causes and outcome of cerebral cortical border-zone infarcts BZI (C-BZI).

Methods The authors prospectively included patients with MRI-confirmed C-BZI among individuals consecutively admitted in Stroke Unit.

Results Forty-five patients presented C-BZI out of 589 with MRI-confirmed cerebral infarcts (7.6%). Particular clinical characteristics existed in C-BZI in comparison with other cerebral infarctions as a whole, including: (1) frequent transient symptoms at onset (27% vs 9%; p<0.001) and low severity score (NIHSS=3.1±3.0 vs 5.2±6.1; p=0.02); (2) early seizures in first 2 weeks (7/45 (15.6%) vs 12/544 (2.2%); p<0.001), even when focusing only on other infarctions involving the cerebral cortex (15.6% vs 4.3%; p<0.01); (3) heterogeneous clinical presentation but specific transcortical aphasia allowing a clinical suspicion of BZI before MRI; and (4) frequently associated internal carotid disease (69%), with subsequent early surgery in 75% of the cases. Following adapted care in stroke unit, C-BZIs' prognosis appeared good (Rankin score ≤2 at D90) for 82% of the patients.

Conclusion Some clinical features are overrepresented in such infarctions, including initial transient symptoms preceding the onset of a completed deficit, transcortical aphasia and early seizures. Despite lower initial severity, C-BZIs justify early management in stroke unit, often followed by carotid surgery, leading to an overall good prognosis.

  • Watershed infarct
  • border-zone
  • transient ischaemic attack
  • endarterectomy
  • early seizures
  • transcortical mixt aphasia
  • carotid stenosis
  • prognosis
  • aphasia
  • cerebrovascular disease
  • movement disorders
  • dysphagia
  • metabolic disease
  • stroke
  • multiple sclerosis
  • cardiology
  • amyloid
  • neuropathy
  • peripheral neuropathology
  • paraproteinaemia

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Footnotes

  • Competing interests None.

  • Ethics approval Local ethical committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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