HEMODYNAMIC MECHANISM IN SMALL SUBCORTICAL BORDERZONE INFARCTS

In 143 consecutive, prospectively registered patients with a first-eve r stroke due to a small subcortical infarct, we identified 12 patients with a symptomatic small subcortical infarct in the borderzone betwee n the areas supplied by the deep penetrators and the medullary branche s of the middle cerebral artery. Four of these had ipsilateral carotid stenosis of more than 50% (1 with total occlusion), as opposed to 3 o f 62 remaining patients with CT-confirmed small deep infarcts (odds ra tio: 9.83; 95% confidence interval: 1.70-57.04; p < 0.01). The number of patients with a potential cardio-embolic cause did not differ, whic h makes cardiac embolism a less likely cause of such infarcts. Althoug h in many patients with small deep infarcts local small-vessel obstruc tion may be the underlying cause, small deep infarcts located in a bor derzone may be caused by a haemodynamic mechanism.