Cortical border-zone infarcts: clinical features, causes and outcome
- Claire Joinlambert1,
- Guillaume Saliou2,
- Constance Flamand-Roze1,
- Pascal Masnou1,
- Mariana Sarov1,
- Raphaelle Souillard2 3,
- Marie Saliou-Théaudin1,
- Thierry Guedj1,
- Patrick Assayag3,4,
- Denis Ducreux2,3,5,
- David Adams1,3,5,
- Christian Denier1,5
- 1Department of Neurology, Bicêtre Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- 2Department of Neuroradiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- 3PARIS XI - Sud University, Le Kremlin-Bicêtre, France
- 4Department of Cardiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- 5INSERM U788, Le Kremlin-Bicêtre, France
- 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;
Contributors Acquisition of data: Join-Lambert, Flamand-Roze, Masnou, Guedj and Denier. Analysis and interpretation of data: Saliou, Masnou, Sarov, Souillard, Saliou-Théaudin, Assayag, Ducreux, Adams and Denier. Drafting of the manuscript: Join-Lambert and Denier. Critical revision of the manuscript for important intellectual content: Flamand-Roze, Masnou, Assayag, Ducreux, Adams and Denier. Statistical analysis: Join-Lambert and Denier.
- Received 30 January 2012
- Revised 31 March 2012
- Accepted 24 April 2012
- Published Online First 13 June 2012
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
- transient ischaemic attack
- early seizures
- transcortical mixt aphasia
- carotid stenosis
- cerebrovascular disease
- movement disorders
- metabolic disease
- multiple sclerosis
- peripheral neuropathology
Competing interests None.
Ethics approval Local ethical committee.
Provenance and peer review Not commissioned; externally peer reviewed.