Supratentorial subcortical infarct syndromes

Question 1

Types of subcortical infarcts

Answer 1

1. Lacunar infarct
2. Striatocapsular infarct

Question 2

What is lacunar infarct?

Answer 2

• Subcortical infarct - disruption of white matter tracts
• < 1.5cm in diameter

Question 3

Lacunar syndromes

Answer 3

1. Pure motor stroke
2. Pure sensory stroke
3. Sensorimotor stroke
4. Ataxic hemiparesis
5. Clumsy hand and dysarthria syndrome

Question 4

What is striatocapsular infarct?

Answer 4

Infarct in striatocapsular region
- Corpus striatum
- Internal capsule

Comma-shaped, larger than upper limit of lacunar infarct ( > 1.5cm)

NOT small vessel disease
Vessel: transient occlusion of MCA (embolus), resulting in ischaemia in both:
- Territory of perforating arteries from MCA
> End-artery with no collateral supply -> frequently infarcted
- Regions of cortex supplied by MCA
> has collateral supply

Post-thrombolysis -> reperfusion and sparing of cortex while striatocapsular region is permanently infarcted

Question 5

Features of striatocapsular infarct

Answer 5

Striatocapsular region (usually permanent)
- Contralateral hemiparesis
- Contralateral hemisensory loss

Cortical region (may be transient once areas reperfused)
- Dysphasia
- Neglect
- Hemianopia

Question 6

Importance of striatocapsular infarct

Answer 6

Large vessel disease
- Embolism from heart or carotif artery
- MCA stenosis

Evaluation of cardioembolic sources
- TTE for thrombus
- Telemetry for AF