Objective: The mechanism underlying cerebral infarction in the borderzone between the territories of deep and superficial perforating arteries has not yet been clarified. This study was performed to investigate the prevalence, volume, site, and etiology of this type of subcortical infarction in a large unselected group of stroke patients. Methods and Patients: We analyzed a continuous series of 383 patients with recent cerebral infarction observed in our Stroke Unit. Patients underwent a complete clinical and instrumental workup. The subgroup of subjects with internal borderzone infarct alone were compared with the subgroups of patients with other types of cerebral infarcts by uni- and multivariate statistical tests. Results: There were 90 internal borderzone infarcts of 725 ischemic lesions (12% of the total), with a median volume of 0.32 ml (95% confidence interval 0.24–0.44; range: 0.012–20.2 ml). Internal borderzone infarcts alone occurred in only 13 of 383 (3.4%) patients. A comparison between patients with ‘pure’ internal borderzone infarction and patients with other types of cerebral infarcts by multiple logistic regression analysis demonstrated a significant independent causal role of carotid stenosis or occlusion. Conclusion: Our study suggests that ‘pure’ internal borderzone infarctions are quite rare findings in patients with ischemic stroke, and that the hemodynamic impairment due to atherosclerotic occlusion or stenosis of the carotid system could be the cause in the large majority of cases.

1.
Bogousslavsky J, Regli F: Centrum ovale infarcts: Subcortical infarction in the superficial territory of the middle cerebral artery. Neurology 1992;42:1992–1998.
2.
Donnan GA, Norvving B, Bamford JM, Bogousslavsky J: Subcortical infarctions: Classification and terminology. Cerebrovasc Dis 1993;3:248–251.
3.
Del Sette M, Eliasziw M, Streifler JY, Hachinski VC, Fox AJ, Barnett HJM: Internal borderzone infarction: A marker for severe stenosis in patients with symptomatic carotid artery disease. Neurology, in press.
4.
Bladin CF, Chambers BR: Clinical features, pathogenesis and computed tomographic characteristics of internal watershed infarction. Stroke 1993;24:1925–1932.
5.
Hupperts RMM, Lodder J, Wilmink J, Boiten J, Heuts-van Raak EPM: Haemodynamic mechanism in small subcortical borderzone infarcts? Cerebrovasc Dis 1993;3:231–235.
6.
Mounier-Vehier F, Leys D, Godefroy O, Rondepierre PH, Marchau M Jr, Pruvo JP: Borderzone infarct subtypes: Preliminary study of the presumed mechanism. Eur Neurol 1994;34:11–15.
7.
Damasio H: A computer tomographic guide to the identification of cerebral vascular territories. Arch Neurol 1983;40:138–142.
8.
Zülch KJ: The cerebral infarct: Pathology, pathogenesis and computed tomography. Berlin, Springer, 1985.
9.
Adams HP, Bendixen BH, Kapelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, and the TOAST Investigators: Classification of subtype of acute ischemic stroke: Definition for use in a multicenter clinical trial. Stroke 1993;24:35–41.
10.
Loeb C, Gandolfo C, Del Sette M, Conti M, Finocchi C, Calautti C: Asymptomatic cerebral infarction in patients with ischemic stroke. Eur Neurol 1996;36:343–347.
11.
Wozard R: Watershed infarctions and computed tomography. A topographical study in case with stenosis or occlusion of the carotid artery. Neuroradiology 1980;19:245–248.
12.
Bogousslavsky J, Regli F: Borderzone infarctions distal to internal carotid artery occlusion: Prognostic implications. Ann Neurol 1986;20:346–350.
13.
Steinke W, Schwartz A, Hennerici M: Topography of cerebral infarction associated with carotid artery dissection. J Neurol 1996;243:323–328.
14.
Mull M, Schwarz M, Thron A: Cerebral hemispheric low-flow infarcts in arterial occlusive disease. Stroke 1997;28:118–123.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.