Computed Tomography Patterns of Brain Infarctions as a Pathogenetic Key

  • H. Zeumer
  • E. B. Ringelstein


Traditionally, differentiation of patients suffering from ischemic strokes was based on clinical findings and the course of the disease. Categories such as transient ischemic attacks (TIA), prolonged reversible ischemic neurological deficit (PRIND), and completed stroke have been used as major criteria for stroke classification and consequently for therapeutic decision-making. Before CT became available, and when angiography was still widely used as the basic diagnostic tool for imaging of cerebrovascular disease, virtually any type and degree of carotid lesion could be correlated with numerous hemispheric ischemic events. This was also true of cerebrovascular accidents and associated arterial lesions within the vertebrobasilar system. Hemodynamic mechanisms were thought to be the major factors in the pathophysiology of stroke.


Brain Infarction Periventricular White Matter Lacunar Stroke Territorial Infarction Lacunar Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bladin PF, Berkovic SF (1984) Striatocapsular infarction: Large infarcts in the lenticulostriate arterial territory. Neurology 34: 1423–1430PubMedGoogle Scholar
  2. 2.
    Bruckmann H, Ferbert A, del Zoppo GJ, Hacke W, Ringelstein EB, Zeumer H (1986) The acute vertebral-basilar thrombosis: angiological-clinical comparison and therapeutic implications. Acta Radiol 369: 38–42 (Suppl)Google Scholar
  3. 3.
    Caplan LR, Rosenbaum AE (1975) Role of cerebral angiography in vertebro-basilar occlusive disease. J Neurol Neurosurg Psychiat 38: 601–612PubMedCrossRefGoogle Scholar
  4. 4.
    Caplan LR, Schoene W (1978) Clinical features of subcortical arteriosclerotic encephalopathy ( Binswanger Disease ). Neurology 28: 1206–1215PubMedGoogle Scholar
  5. 5.
    Chokroverty CS, Rubino FA, Haller C (1977) Pure motor hemiplegia due to cerebral cortical infarction. Arch Neurol 34: 93–95PubMedGoogle Scholar
  6. 6.
    Cioffi FA, Bernini FP, Punzo A, Avanzo RD (1985) Surgical management of acute cerebellar infarction. Acta Neurochirurgica 74: 105–112PubMedCrossRefGoogle Scholar
  7. 7.
    De Reuck J, Vander Eecken H (1976) The arterial angioarchitecture in lacunar state. Acta Neurol Belg 76: 142–149PubMedGoogle Scholar
  8. 8.
    De Witt LD (1986) Clinical use of nuclear magnetic resonance imaging in stroke. Stroke 17: 328–331CrossRefGoogle Scholar
  9. 9.
    Ferbert A, Zeumer H, Ringelstein EB (1985) Dopplersonographische Befunde beim ischamischen Hirninfarkt unterschiedlicher Pathogenese. Akt. Neurol. 12: 153–157CrossRefGoogle Scholar
  10. 10.
    Fisher CM (1969) The arterial lesions underlying lacunes. Acta Neuropathol. 12: 1–15CrossRefGoogle Scholar
  11. 11.
    Fisher CM (1982) Lacunar strokes and infarcts: a review. Neurology 32: 871–876PubMedGoogle Scholar
  12. 12.
    Fisher M, McQuillen JB (1981) Bilateral cortical border-zone infarction. Arch Neurol 38: 62–63PubMedGoogle Scholar
  13. 13.
    Fox AJ, Bogousslavsky J, Carey LS, Barnett HJM, Vinitski H, Karlik SJ, Vinuela F, Pelz DM, Hachinski V (1986) Magnetic resonance imaging of small medullary infarctions. AJNR 7: 229–233PubMedGoogle Scholar
  14. 14.
    George AE, DeLeon M, Gentes CI, Miller J, London E, Budzilovich G, Ferris S, Chase N (1984) Leukoencephalopathy of aging: CT clinical-neuropathologic study of brain lucencies. AJNR 5: 678Google Scholar
  15. 15.
    Guse F, Weiller C, Bruckmann H, Ringelstein EB (1987) Zur Abhangigkeit des Hirninfarktrisikos vom Schweregrad okkludierender Karotis interna-Lasionen. Nervenarzt 58 (in press)Google Scholar
  16. 16.
    Jellinger K, Neumayr E (1964) Progressive subkortikale vaskulare Encephalopathie Binswanger: eine klinisch-neuropathologische Studie. Arch Psychiat Nervenkr 285: 523–554CrossRefGoogle Scholar
  17. 17.
    Mohr JP (1977) Sensorimotor stroke due to thalamocapsular ischemia. Arch Neurol 34: 739–741PubMedGoogle Scholar
  18. 18.
    Mori E, Tabuchi J, Yamadori A (1985) Lacunar syndrome due to intracerebral hemorrhage. Stroke 16: 454–459PubMedCrossRefGoogle Scholar
  19. 19.
    Nelson RF, Pullicino R, Kendall BE, Marshall J (1980) Computed tomography in patients presenting with lacunar syndromes. Stroke 11: 256–261PubMedCrossRefGoogle Scholar
  20. 20.
    Olsen TS, Skriver C, Herning M (1985) Cause of cerebral infarction in the carotid territory: its relation to the size and the location of the infarct and to the underlying vascular lesion. Stroke 16: 459–466PubMedCrossRefGoogle Scholar
  21. 21.
    Olszewski J (1962) Subcortical arteriosclerotic encephalopathy. World Neurol 3: 359 - 364PubMedGoogle Scholar
  22. 22.
    Rodda RA, Path FRC (1986) The arterial patterns associated with internal carotid and cerebral infarcts. Stroke 17: 69–75PubMedCrossRefGoogle Scholar
  23. 23.
    Ringelstein EB, Zeumer H, Angelou D (1983) The pathogenesis of strokes from internal carotid artery occlusion. Diagnostic and therapeutical implications. Stroke 14: 867–875PubMedCrossRefGoogle Scholar
  24. 24.
    Ringelstein EB, Zeumer H, Schneider R (1985) Der Beitrag der zerebralen Computertomographie zur Differentialtypologie und Differentialtherapie des ischamischen GroBhirninfarktes. Fortsch Neurol Psychiat 9: 315–354CrossRefGoogle Scholar
  25. 25.
    Schneider M (1953) Durchblutung und Sauerstoffversorgung des Gehirns. Verh Dtsch Ges Kreisl Forsch 19: 3–25Google Scholar
  26. 26.
    Schneider R, Korber N, Zeumer H, Kiesewetter H, Ringelstein EB, Brockmann M (1985) The haemorheological features of lacunar strokes. J Neurol 232: 357–359PubMedCrossRefGoogle Scholar
  27. 27.
    Taneda M, Shimada N, Tsuchiya T (1985) Transient neurological deficits due to embolic occlusion and reopening of the cerebral arteries. Stroke 16: 522–534PubMedCrossRefGoogle Scholar
  28. 28.
    Weisberg LA (1982) Lacunar infarcts: clinical and computed tomographic correlations. Arch Neurol 39: 37–40PubMedGoogle Scholar
  29. 29.
    Wodarz R (1980) Watershed infarctions and computed tomography. A topographical study in cases with stenosis or occlusion of the carotid artery. Neuroradiology 19: 245–248PubMedGoogle Scholar
  30. 30.
    Zeumer H, Hacke W (1982) Zur Frage der Multiinfarktdemenz unter besonderer Berucksichti- gung computertomographischer Befunde. Fortsch Neurol Psychiat 50: 366–367CrossRefGoogle Scholar
  31. 31.
    Zeumer H, Hacke W, Hundgen R (1981) Subkortikale arteriosklerotische Encephalopathie: klini- sche, CT-morphologische und elektrophysiologische Befunde. Fortsch Neurol Psychiat 49: 223–231CrossRefGoogle Scholar
  32. 32.
    Zeumer H, Ringelstein EB, Klose FC (1981) Lakunare Infarkte im Computertomogramm: Diffe- rentialdiagnose, klinische und angiographische Befunde. Fortschr Rontgenstr 134: 488–494CrossRefGoogle Scholar
  33. 33.
    Zeumer H, Schonsky B, Sturm KW (1980) Predominant white matter involvement in subcortical arteriosclerotic encephalopathy ( Binswanger Disease ). J Comput Assist Tomogr 4: 14–19PubMedCrossRefGoogle Scholar
  34. 34.
    Zeumer H, Hacke W (1986) Ischamische Insulte. In: Hacke W (ed) Neurologische Inten- sivmedizin. perimed, ErlangenGoogle Scholar
  35. 35.
    Zülch KJ (1985) The cerebral infarct. Pathology, pathogenesis and computed tomography. Springer, Berlin Heidelberg New York TokyoGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • H. Zeumer
    • 1
  • E. B. Ringelstein
    • 1
  1. 1.Department of Neurology, Klinikum RWTHUniversity HospitalAachenGermany

Personalised recommendations