Edinburgh Imaging

01 May 19. Featured Paper

Are morphologic features of recent small subcortical infarcts related to specific etiologic aspects?

Link to paper on Therapeutic Advances in Neurological Disorders.



Sebastian Eppinger, Thomas Gattringer, Lena Nachbaur, Simon Fandler, Lukas Pirpamer, Stefan Ropele, Joanna Wardlaw, Christian Enzinger and Franz Fazekas



Background: Recent small subcortical infarcts (RSSIs) mostly result from the occlusion of a single, small, brain artery due to intrinsic cerebral small-vessel disease (CSVD).

Some RSSIs may be attributable to other causes such as cardiac embolism or large-artery disease, and their association with coexisting CSVD and vascular risk factors may vary with morphological magnetic resonance imaging (MRI) features.


Methods: We retrospectively identified all inpatients with a single symptomatic MRI-confirmed RSSI between 2008 and 2013.

RSSIs were rated for size, shape, location (i.e. anterior: basal ganglia and centrum semiovale posterior cerebral circulation: thalamus and pons) and MRI signs of concomitant CSVD. In a further step, clinical data, including detailed diagnostic workup and vascular risk factors, were analyzed with regard to RSSI features.


Results: Among 335 RSSI patients (mean age 71.1 ± 12.1years), 131 (39%) RSSIs were >15mm in axial diameter and 66 (20%) were tubular shaped.

Atrial fibrillation (AF) was present in 44 (13.1%) and an ipsilateral vessel stenosis > 50% in 30 (9%) patients.

Arterial hypertension and CSVD MRI markers were more frequent in patients with anterior-circulation RSSIs, whereas diabetes was more prevalent in posterior-circulation RSSIs.

Larger RSSIs occurred more frequently in the basal ganglia and pons, and the latter were associated with signs of largeartery atherosclerosis.

Patients with concomitant AF had no specific MRI profile.


Conclusion: Our findings suggest the contribution of different pathophysiological mechanisms to the occurrence of RSSIs in the anterior and posterior cerebral circulation.

While there appears to be some general association of larger infarcts in the pons with large-artery disease, we found no pattern suggestive of AF in RSSIs.