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X-ray computed tomography (CT) study of small, deep and recent infarcts (SDRIs) of the cerebral hemispheres in adults

Preliminary and critical report

  • Second Part Roles of Scanning: CT, PET and MRI
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Summary

The evolution of CT signs of small, deep infarcts of the cerebral hemispheres in thirty adults, in the first five weeks, has been retrospectively studied. The relevant literature has been reviewed and an attempt has been made to present a synthesis, accompanied by a commentary. It is impossible now to give the frequency of each type of evolution, but the main data are as follows: 1. The shortest delay of visibility of an hypodense area is about 17 to 19h, but at 27 h the densities may still be normal. 2. The evolution of the hypodense area is also variable: after a minimum attenuation is reached-at approximately 72 h-there is a risk of “fogging effect”, which reduces the visibility of ischemic lesions; it could be seen from the end of the 1st week to the beginning of the 4th, but its frequency and its duration have yet to be better determined. 3. In our series, contrast enhancement has been found in the gray matter of the basal ganglia between the 8th and the 22nd days-but according to some observations recorded in the literature, it may be found from the second to the twenty sixth day-and there was no obvious contrast enhancement in the white matter. The significance of the evolving CT signs is discussed in connection with the clinical applications, principally in the management of these patients, and with the attempts to correlate the clinical and CT findings.

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References

  1. Alex M, Baron EK, Goldenberg S, Blumenthal HT (1962) An autopsy study of cerebrovascular accident in diabetes mellitus. Circulation 25:663–673

    Google Scholar 

  2. Araki G, Mihara H, Shizuka M, Yunoki K, Nagata K, Yamaguchi K, Mizukami M, Kawase T, Tazawa T (1983) CT and arteriographic comparison of patients with transient ischemic attacks — Correlation with small infarction of basal ganglia. Stroke 14:276–280

    Google Scholar 

  3. Archer CR, Ilinsky IA, Goldfader PR, Smith KR, Jr (1981) Aphasia in thalamic stroke: CT stereotactic localization. J Comput Assist Tomogr 5:427–432

    Google Scholar 

  4. Aronson SM (1973) Intracranial vascular lesions in patients with diabetes mellitus. J Neuropathol Exp Neurol 32:183–196

    Google Scholar 

  5. Becker H, Desch H, Hacker H, Pencz A (1979) CT fogging effect with ischemic cerebral infarcts. Neuroradiology 18: 185–192

    Google Scholar 

  6. Bergström M, Ericson K (1979) Compartment analysis of contrast enhancement in brain infarctions. J Comput Assist Tomogr 3:234–240

    Google Scholar 

  7. Bogousslavsky J, Regli F (1984) Cerebral infarction with transient signs (CITS): do TIAs correspond to small deep infarcts in internal carotid artery occlusion? Stroke 15:536–539

    Google Scholar 

  8. Bogousslavsky J, Regli F (1984) Hemiparésie avec atteinte linguale. Hématome du genou de la capsule interne. Rev Neurol (Paris) 140:587–590

    Google Scholar 

  9. Caillé JM, Guibert F, Bidabé AM, Billerey J, Piton J (1980) Enhancement of cerebral infarcts with CT. Comput Radiol 4: 73–77

    Google Scholar 

  10. Chokroverty S, Rubino FA (1975) “Pure” motor hemiplegia. J Neurol Neurosurg Psychiatry 38:896–899

    Google Scholar 

  11. Cole FM, Yates P (1967) Intracerebral microaneurysms and small cerebrovascular lesions. Brain 90:759–767

    Google Scholar 

  12. Critchley EMR (1983) Recognition and management of lacunar strokes. Br Med J [Clin Res] 287:777–778

    Google Scholar 

  13. Dehaene I (1982) Bilateral thalamo-subthalamic infarction. Acta Neurol Belg 82:253–261

    Google Scholar 

  14. De Renzi E, Nichelli P, Crisi G (1983) Hemiataxia and crural hemiparesis following capsular infarct. J Neurol Neurosurg Psychiatry 46:561–563

    Google Scholar 

  15. De Reuck J, Crevits L, De Coster W, Sieben G, vander Eecken H (1980) Pathogenesis of Binswanger chronic progressive subcortical encephalopathy. Neurology (NY) 30:920–928

    Google Scholar 

  16. De Reuck J, vander Eecken H (1976) The arterial angioarchitecture in lacunar state. Acta Neurol Belg 76:142–149

    Google Scholar 

  17. Derouesné C, Mas J-L, Bolgert F, Castaigne P (1984) Pure sensory stroke caused by a small cortical infarct in the middle cerebral artery territory. Stroke 15:660–662

    Google Scholar 

  18. Donnan GA, Tress BM, Bladin PF (1982) A prospective study of lacunar infarction using computerized tomography. Neurology (NY) 32:49–56

    Google Scholar 

  19. Drayer BP, Dujovny M, Wolfson SK, Jr., Boehnke M, Cook EE, Rosenbaum AE (1979) Comparative cranial CT enhancement in a primate model of cerebral infarction. Ann Neurol 5: 48–58

    Google Scholar 

  20. Englander RN, Netsky MG, Adelman LS (1975) Location of human pyramidal tract in the internal capsule: anatomic evidence. Neurology (NY) 25:823–826

    Google Scholar 

  21. Fisher CM (1965) Pure sensory stroke involving face, arm, and leg. Neurology (NY) 15:76–80

    Google Scholar 

  22. Fisher CM (1965) Lacunes: small, deep cerebral infarcts. Neurology (NY) 15:774–784

    Google Scholar 

  23. Fisher CM (1969) The arterial lesions underlying lacunes. Acta Neuropathol (Berl) 12:1–15

    Google Scholar 

  24. Fisher CM (1972) Cerebral miliary aneurysms in hypertension. Am J Pathol 66:313–342

    Google Scholar 

  25. Fisher CM (1978) Thalamic pure sensory stroke: a pathologic study. Neurology (NY) 28:1141–1144

    Google Scholar 

  26. Fisher CM (1979) Capsular infarcts. The underlying vascular lesions. Arch Neurol 36:65–73

    Google Scholar 

  27. Fisher CM (1982) Pure sensory stroke and allied conditions. Stroke 13:434–447

    Google Scholar 

  28. Fisher CM (1982) Lacunar strokes and infarcts: a review. Neurology (NY) 32:871–876

    Google Scholar 

  29. Fisher CM, Curry HB (1965) Pure motor hemiplegia of vascular origin. Arch Neurol 13:30–44

    Google Scholar 

  30. Gado M, Danziger WL, Chi D, Hughes CP, Coben LA (1983) Brain parenchymal density measurements by CT in demented subjects and normal controls. Radiology 147:703–710

    Google Scholar 

  31. Goldenberg G, Reisner Th (1983) Angiographic findings in relation to clinical course and results of computed tomography in cerebrovascular disease. Eur Neurol 22:124–130

    Google Scholar 

  32. Goto K, Ishii N, Fukasawa H (1981) Diffuse white-matter disease in the geriatric population. A clinical, neuropathological, and CT study. Radiology 141:687–695

    Google Scholar 

  33. Goto K, Tagawa K, Uemura K, Ishii K, Takahashi S (1979) Posterior cerebral artery occlusion: clinical, computed tomographic, and angiographic correlation. Radiology 132:357–368

    Google Scholar 

  34. Graff-Radford NR, Eslinger PJ, Damasio AR, Yamada T (1984) Nonhemorrhagic infarction of the thalamus: behavioral, anatomic, and physiologic correlates. Neurology (NY) 34: 14–23

    Google Scholar 

  35. Hakim AM, Ryder-Cooke A, Melanson D (1983) Sequential computerized tomographic appearance of strokes. Stroke 14: 893–897

    Google Scholar 

  36. Houser OW, Campbell JK, Baker HL, Jr, Sundt TS, Jr (1982) Radiologic evaluation of ischemic cerebrovascular syndromes with emphasis on computed tomography. Radiol Clin North Am 20:123–142

    Google Scholar 

  37. Huang CY, Lui FS (1984) Ataxic-hemiparesis, localization and clinical features. Stroke 15:363–366

    Google Scholar 

  38. Ichikawa K, Tsutsumishita A, Fujioka A (1982) Capsular ataxic hemiparesis. A case report. Arch Neurol 39:585–586

    Google Scholar 

  39. Inoue Y, Takemoto K, Miyamoto T, Yoshikawa N, Taniguchi S, Saiwai S, Nishimura Y, Komatsu T (1980) Sequential computed tomography scans in acute cerebral infarction. Radiology 135:655–662

    Google Scholar 

  40. Iragui VJ, McCutchen CB (1982) Capsular ataxic hemiparesis. Arch Neurol 39:528–529

    Google Scholar 

  41. Jacome DE (1983) Homolateral ataxia and crural paresis. Arch Neurol 40:659–660

    Google Scholar 

  42. Jokelainen M, Pilke A (1983) Ataxic hemiparesis. Arch Neurol 40:326

    Google Scholar 

  43. Kase CS, Maulsby GO, de Juan E, Mohr JP (1981) Hemichorea-hemiballism and lacunar infarction in the basal ganglia. Neurology (NY) 31:452–455

    Google Scholar 

  44. Kawase T, Mizukami M, Araki G (1981) Mechanisms of contrast enhancement in cerebral infarction: computerized tomography, regional cerebral blood flow, fluorescein angiography, and pathological study. Adv. Neurol 30:149–158

    Google Scholar 

  45. Kendall BE, Pullicino P (1980) Intravascular contrast injection in ischaemic lesions. II. Effect on prognosis. Neuroradiology 19:241–243

    Google Scholar 

  46. Manelfe C, Clanet M, Gigaud M, Bonafé A, Guiraud B, Rascol A (1981) Internal capsule: normal anatomy and ischemic changes demonstrated by computed tomography. AJNR 2: 149–155

    Google Scholar 

  47. Masuda J, Tanaka K, Omae T, Ueda K, Sadoshima S (1983) Cerebrovascular diseases and their underlying vascular lesions in Hisayama, Japan — A pathological study of autopsy cases. Stroke 14:934–940

    Google Scholar 

  48. Miller VT (1983) Lacunar stroke. A reassessment. Arch Neurol 40:129–134

    Google Scholar 

  49. Mohr JP (1982) Lacunes. Stroke 13:3–11

    Google Scholar 

  50. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, Pessin MS, Bleich HL (1978) The Harvard cooperative stroke registry: a prospective registry. Neurology (NY) 28: 754–762

    Google Scholar 

  51. Mohr JP, Kase CS, Meckler RJ, Fisher CM (1977) Sensorimotor stroke due to thalamocapsular ischemia. Arch Neurol 34: 739–741

    Google Scholar 

  52. Nelson RF, Pullicino P, Kendall BE, Marshall J (1980) Computed tomography in patients presenting with lacunar syndromes. Stroke 11:256–261

    Google Scholar 

  53. Newton TH, Potts DG (eds) (1981) Radiology of the skull and brain vol V. Technical aspects of computed tomography. Mosby, St Louis Toronto London

    Google Scholar 

  54. Norton GA, Kishore PRS, Lin J (1978) CT contrast enhancement in cerebral infarction. AJR 131:881–885

    Google Scholar 

  55. Olsen TS, Christensen J, Skriver EB, Lassen NA (1983) Brain scintigraphy with Tc99-pertechnetate in the evaluation of patients with cerebrovascular lesions. The diagnosic value related to age of the lesion and to the size, type and localisation revealed by CT-scan. Acta Neurol Scand 67:229–234

    Google Scholar 

  56. Pentlow KS (1981) Dosimetry in computed tomography. In: Newton TH, Potts DG (eds) pp 4228–4258

  57. Perman GP, Racy A (1980) Homolateral ataxia and crural paresis: case report. Neurology (NY) 30:1013–1015

    Google Scholar 

  58. Pullicino P, Kendall BE (1980) Contrast enhancement in ischaemic lesions. I. Relationship to prognosis. Neuroradiology 19:235–239

    Google Scholar 

  59. Pullicino P, Nelson RF, Kendall BE, Marshall J (1980) Small deep infarcts diagnosed on computed tomography. Neurology (NY) 30:1090–1096

    Google Scholar 

  60. Rascol A, Clanet M, Manelfe C, Guiraud B, Bonafé A (1982) Pure motor hemiplegia: CT study of 30 cases. Stroke 13:11–17

    Google Scholar 

  61. Roehmholdt ME, Palumbo PJ, Whisnant JP, Elveback LR (1983) Transient ischemic attack and stroke in a communitybased diabetic cohort. Mayo Clin Proc 58:56–58

    Google Scholar 

  62. Rosenberg NL, Koller R (1981) Computerized tomography and pure sensory stroke. Neurology (NY) 31:217–220

    Google Scholar 

  63. Skriver EB, Olsen TS (1981) Transient disappearance of cerebral infarcts on CT scan, the so-called fogging effect. Neuroradiology 22:61–65

    Google Scholar 

  64. Skriver EB, Olsen TS (1982) Contrast enhancement of cerebral infarcts. Incidence and clinical value in different states of cerebral infarction. Neuroradiology 23:259–265

    Google Scholar 

  65. Soisson T, Cabanis EA, Iba-Zizen MT, Bousser MG, Laplane D, Castaigne P (1982) Pure motor hemiplegia and computed tomography. 19 cases. J Neuroradiol 9:304–322

    Google Scholar 

  66. Spertell RB, Ransom BR (1979) Dysarthria-clumsy hand syndrome produced by capsular infarct. Ann Neurol 6:263–265

    Google Scholar 

  67. Terent A, Ronquist G, Bergström K, Hällgren R, Åberg H (1981) Ischemic edema in stroke. A parallel study with computed tomography and cerebrospinal fluid markers of disturbed brain cell metabolism. Stroke 12:33–40

    Google Scholar 

  68. Thaler HT, Rottenberg DA, Pentlow KS, Allen JC (1979) A method of correcting for linear drift in computed tomography brain scans. J Comput Assist Tomogr 3:251–255

    Google Scholar 

  69. Tohgi H, Mochizuki H, Yamanouchi H, Iio M, Yamada H, Chiba K, Tomonaga M (1981) A comparison between the computed tomogram and the neuropathological findings in cerebrovascular disease. J Neurol 224:211–220

    Google Scholar 

  70. Torack RM (1982) Computed tomography and stroke edema: case report with an analysis of water in acute infarction. Comput Radiol 6:35–41

    Google Scholar 

  71. Tredici G, Pizzini G, Bogliun G, Tagliabue M (1982) The site of motor corticospinal fibres in the internal capsule of man. A computerised tomographic study of restricted lesions. J Anat 134:199–208

    Google Scholar 

  72. van Gijn J, Kraaijeveld CL (1982) Blood pressure does not predict lacunar infarction. J Neurol Neurosurg Psychiatry 45: 147–150

    Google Scholar 

  73. Wall SD, Brant-Zawadzki M, Jeffrey RB, Barnes B (1981 and 1982) High frequency CT findings within 24 hours after cerebral infarction. AJNR 2:553–557 and AJR 138:307–311

    Google Scholar 

  74. Weisberg LA (1979) Computed tomography and pure motor hemiparesis. Neurology (NY) 29:490–495

    Google Scholar 

  75. Weisberg LA (1982) Lacunar infarcts: clinical and computed tomographic correlations. Arch Neurol 39:37–40

    Google Scholar 

  76. Zatz LM (1981) General overview of computed tomography instrumentation. In: Newton TH, Potts DG (eds), pp 4025–4057

  77. Zatz LM, Jernigan TL, Ahumada AJ (1982) White matter changes in cerebral computed tomography related to aging. J Comput Assist Tomogr 6:19–23

    Google Scholar 

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  1. Service de Neuroradiologie Charcot, Hôpital de la Salpêtrière, Paris, France

    J. Bories

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  1. M. Launay
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  2. M. N'Diaye
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  3. J. Bories
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Launay, M., N'Diaye, M. & Bories, J. X-ray computed tomography (CT) study of small, deep and recent infarcts (SDRIs) of the cerebral hemispheres in adults. Neuroradiology 27, 494–508 (1985). https://doi.org/10.1007/BF00340845

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