Current Journal of Neurology

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Peer Review Process

Journal Metrics

News

Publication Ethics and Malpractice Statement

Cerebral border zone infarctions: An etiologic study

Document Type : Original Article

Authors

1 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

2 Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran

Abstract

Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients.
Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system.
Results: The study included 106 patients with BZI,
53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction.
Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.

Keywords

References
  1. Pozzi S. On a case of atrophic cirrhosis with granular disseminated cerebral convolutions. Encéphale 1883; 3: 155-77. [In French.
  2. Zulch KJ, Behrend RCH. The pathogenesis and topography of anoxy, hypoxia and ischemia of the brain in man. In: Meyer JF, Gastaut H, editors. Cerebral anoxia and the electroencephalogram. Springfield, IL: Charles C. Thomas; 1961. p. 144-63.
  3. Cauquil-Michon C, Flamand-Roze C, Denier C. Borderzone strokes and transcortical aphasia. Curr Neurol Neurosci Rep 2011; 11(6): 570-7.
  4. Mangla R, Kolar B, Almast J, Ekholm SE. Border zone infarcts: Pathophysiologic and imaging characteristics. Radiographics 2011; 31(5): 1201-14.
  5. Wang Y, Wang J. Clinical and imaging features in different inner border-zone infarct patterns. Int J Neurosci 2015; 125(3): 208-12.
  6. Bogousslavsky J, Regli F. Borderzone infarctions distal to internal carotid artery occlusion: prognostic implications. Ann Neurol 1986; 20(3): 346-50.
  7. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 2019; 140(11): e563-e595.
  8. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35-41.
  9. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128(16): 1810-52.
  10. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Beasley TM, et al. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 22(7): e207-e213.
  11. Yong SW, Bang OY, Lee PH, Li WY. Internal and cortical border-zone infarction: Clinical and diffusion-weighted imaging features. Stroke 2006; 37(3): 841-6.
  12. Shi J, Meng R, Konakondla S, Ding Y, Duan Y, Wu D, et al. Cerebral watershed infarcts may be induced by hemodynamic changes in blood flow. Neurol Res 2017; 39(6): 538-44.
  13. Bogousslavsky J, Regli F. Unilateral watershed cerebral infarcts. Neurology 1986; 36(3): 373-7.
  14. Leblanc R, Yamamoto YL, Tyler JL, Diksic M, Hakim A. Borderzone ischemia. Ann Neurol 1987; 22(6): 707-13.
  15. Bladin CF, Chambers BR. Clinical features, pathogenesis, and computed tomographic characteristics of internal watershed infarction. Stroke 1993; 24(12): 1925-32.
  16. Mull M, Schwarz M, Thron A. Cerebral hemispheric low-flow infarcts in arterial occlusive disease. Lesion patterns and angiomorphological conditions. Stroke 1997; 28(1): 118-23.
  17. Gandolfo C, Del Sette M, Finocchi C, Calautti C, Loeb C. Internal borderzone infarction in patients with ischemic stroke. Cerebrovasc Dis 1998; 8(5): 255-8.
  18. van der Grond J, van Everdingen KJ, Eikelboom BC, Kenez J, Mali WP. Assessment of borderzone ischemia with a combined MR imaging-MR angiography-MR spectroscopy protocol. J Magn Reson Imaging 1999; 9(1): 1-9.
  19. Del SM, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJ. Internal borderzone infarction: A marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group. Stroke 2000; 31(3): 631-6.
  20. Lareyre F, Raffort J, Weill C, Marse C, Suissa L, Chikande J, et al. Patterns of acute ischemic strokes after carotid endarterectomy and therapeutic implications. Vasc Endovascular Surg 2017; 51(7): 485-90.
  21. Perini P, Bonifati DM, Tasselli S, Sogaro F. Routine shunting during carotid endarterectomy in patients with acute watershed stroke. Vasc Endovascular Surg 2017; 51(5): 288-94.
  22. El-Gammal TM, Bahnasy WS, Ragab OAA, Al-Malt AM. Cerebral border zone infarction: an etiological study. Egypt J Neurol Psychiatr Neurosurg 2018; 54(1): 6.
  23. Dong MX, Hu L, Huang YJ, Xu XM, Liu Y, Wei YD. Cerebrovascular risk factors for patients with cerebral watershed infarction: A case-control study based on computed tomography angiography in a population from Southwest China. Medicine (Baltimore) 2017; 96(28): e7505.
  24. Sorgun MH, Rzayev S, Yilmaz V, Isikay CT. Etiologic subtypes of watershed infarcts. J Stroke Cerebrovasc Dis 2015; 24(11): 2478-83.
  25. Bergui M, Castagno D, D'Agata F, Cicerale A, Anselmino M, Maria FF, et al. Selective vulnerability of cortical border zone to microembolic infarct. Stroke 2015; 46(7): 1864-9.
  26. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55(11): 1475-82.
  27. Jordan K, Yaghi S, Poppas A, Chang AD, Mac Grory B, Cutting S, et al. Left atrial volume index is associated with cardioembolic stroke and atrial fibrillation detection after embolic stroke of undetermined source. Stroke 2019; 50(8): 1997-2001.
  28. Momjian-Mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke 2005; 36(3): 567-77.
Current Journal of Neurology
Volume 21, Issue 1
January 2022
Pages 1-6
Files
Share
How to cite
Statistics