RT Journal Article
SR Electronic
T1 Cortical border-zone infarcts: clinical features, causes and outcome
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 771
OP 775
DO 10.1136/jnnp-2012-302401
VO 83
IS 8
A1 Claire Joinlambert
A1 Guillaume Saliou
A1 Constance Flamand-Roze
A1 Pascal Masnou
A1 Mariana Sarov
A1 Raphaelle Souillard
A1 Marie Saliou-Théaudin
A1 Thierry Guedj
A1 Patrick Assayag
A1 Denis Ducreux
A1 David Adams
A1 Christian Denier
YR 2012
UL http://jnnp.bmj.com/content/83/8/771.abstract
AB 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.