Infraputaminal ‘lacunes’: Clinical and pathological correlations

Patrick M. Pullicino, Lucia L. Miller, Andrei Alexandrov, Peter T. Ostrow

Research output: Contribution to journalArticle

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Abstract

and PurposeSingle, oval lesions greater than 5 mm in diameter lying inferior to the lateral putamen (infraputaminal lacunes [IPLs]) seen on CT or MR images are commonly reported as lacunar infarcts. To determine the clinical relevance and underlying pathology of IPLs, we evaluated the imaging appearances, clinical features, vascular risk factors, and histopathology in patients with IPLs. MethodsConsecutive MR scans were reviewed for the presence of IPLs. Serial patients seen in routine clinical practice with IPLs were also included. Vascular risk factors were obtained from a prescan questionnaire. Histology and microangiography were performed on postmortem material. A MEDLINE search for putaminal infarcts was performed to look for imaging lesions typical of IPLs. ResultsThree of 100 serial MR scans had IPLs (3%). Nine other patients with in vivo (7) or postmortem (2) MR scans had IPLs. No neurological symptoms could be related to the IPLs. There were no differences in age, hypertension, diabetes, or presence of cortical enlarged perivascular spaces (EPVSs) between patients with and without IPLs. Unlike infarcts, IPLs were isointense with the cerebrospinal fluid on proton density MR sequences. Histological correlation of three MR scans showed IPLs to be a single large EPVS, situated lateral to the anterior commissure. IPLs were located at a point where multiple lenticulostriates turn sharply dorsally. An IPL was the probable cause of the apparent infarct in six publications from peer-reviewed literature that linked different clinical signs to putaminal infarct. ConclusionsIPLs are EPVSs that can be differentiated from infarcts on proton density MR images.

Original languageEnglish (US)
Pages (from-to)1598-1602
Number of pages5
JournalStroke
Volume26
Issue number9
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Protons
Lacunar Stroke
Putamen
MEDLINE
Cerebrospinal Fluid
Publications
Histology
Pathology
Hypertension
vascular factor
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Infraputaminal ‘lacunes’ : Clinical and pathological correlations. / Pullicino, Patrick M.; Miller, Lucia L.; Alexandrov, Andrei; Ostrow, Peter T.

In: Stroke, Vol. 26, No. 9, 01.01.1995, p. 1598-1602.

Research output: Contribution to journalArticle

Pullicino, Patrick M. ; Miller, Lucia L. ; Alexandrov, Andrei ; Ostrow, Peter T. / Infraputaminal ‘lacunes’ : Clinical and pathological correlations. In: Stroke. 1995 ; Vol. 26, No. 9. pp. 1598-1602.
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abstract = "and PurposeSingle, oval lesions greater than 5 mm in diameter lying inferior to the lateral putamen (infraputaminal lacunes [IPLs]) seen on CT or MR images are commonly reported as lacunar infarcts. To determine the clinical relevance and underlying pathology of IPLs, we evaluated the imaging appearances, clinical features, vascular risk factors, and histopathology in patients with IPLs. MethodsConsecutive MR scans were reviewed for the presence of IPLs. Serial patients seen in routine clinical practice with IPLs were also included. Vascular risk factors were obtained from a prescan questionnaire. Histology and microangiography were performed on postmortem material. A MEDLINE search for putaminal infarcts was performed to look for imaging lesions typical of IPLs. ResultsThree of 100 serial MR scans had IPLs (3{\%}). Nine other patients with in vivo (7) or postmortem (2) MR scans had IPLs. No neurological symptoms could be related to the IPLs. There were no differences in age, hypertension, diabetes, or presence of cortical enlarged perivascular spaces (EPVSs) between patients with and without IPLs. Unlike infarcts, IPLs were isointense with the cerebrospinal fluid on proton density MR sequences. Histological correlation of three MR scans showed IPLs to be a single large EPVS, situated lateral to the anterior commissure. IPLs were located at a point where multiple lenticulostriates turn sharply dorsally. An IPL was the probable cause of the apparent infarct in six publications from peer-reviewed literature that linked different clinical signs to putaminal infarct. ConclusionsIPLs are EPVSs that can be differentiated from infarcts on proton density MR images.",
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