HEMODYNAMICALLY CAUSED CEREBRAL INFARCTIO NS - CLINICAL IMPORTANCE OFINFARCT PATTERN AND ANGIOMORPHOLOGY

Classification of brain infarcts based on the location, size and shape of parenchymal damage alone can be difficult and misleading. This is particularly true in subcortical infarctions and infarcts In so-called watershed areas between neighboring territories of the main hemispher ic arteries, Pathogenetic mechanisms, signs and symptoms, lesion patte rns in CT and MRI are discussed as well as angiomorphological conditio ns. Hemodynamically induced low-flow infarcts are rare and show typica l, but nor pathognomic lesion patterns on CT and MRI. Characteristic s ubcortical chainlike and confluent lesions are located in the supra-an d paraventricular white matter; representing the core of a hemodynamic ally induced infarction. Definite diagnosis of low-flow infarcts requi res information on the underlying complex vascular compromise of the e xtra-and intracranial arterial circulation. A noncompetent circle of W illis is the main predisposing condition in hemispheric low-flaw infar cts even in severe occlusive disease of the internal carotid arteries.