Clinical Characteristics of Middle Cerebral Artery Pial Territory? Infarcts

J Korean Neurol Assoc > Volume 13(4); 1995 > Article

Journal of the Korean Neurological Association 1995;13(4): 788-794.

중대뇌연막동맥부 뇌경색의 임상적 양상

이용석, 노재규

서울대학교 신경과

Clinical Characteristics of Middle Cerebral Artery Pial Territory? Infarcts

Yong Seok Lee, M.D., Jae Kyu Roh, M.D.

Department of Neurology, College of Medicine, Seoul National University

Abstract

Infarct limited to the pial branch territory of the middle cerebral artery(IPBMCA) is a common entity of cerebrovascular diseases. Atherothrombosis of middle cerebral (MCA) or internal carotid artery (ICA), and cardiogenic embolism are presumed causes of this type of cerebral infarct. Thirty-three patients with acute IPBMCA were systematically studied with brain CT, MRI, electrocardiography, blood tests, echocardiography, and in selected cases with angiography or MRA. Hypertension(58%) and heart disease(37%) were common risk factors, and previous episodes of TIA were present in 27%. Half of the patients undergoing angiography revealed stenosis or occlusion of MCA, and evidence of carotid disease was found in 39% of patients with large-artery disease(LAD). Presumed causes of infarct were LAD in half and cardioembolism in one-fourth. Multiple combinations of motor weakness, hypesthesia, visual field defect and aphasia or hemineglect were the clinical presentation. Motor weakness was frequent(91%), and involvement of the f ace, arm and leg was the most common pattern. In our study, atherothrombosis of MCA itself is presumed to be the leading cause of IPBMCA in Korea, but cardioembolism, artery-to-artery embolism from proximal ICA, and occlusion of ICA are also supposed to contribute to the pathogenesis of IPBMCA.