ROLE OF CEREBRAl EMBOLISM IN THE PATHOGENESIS OF LACUNAR INFARCTION

Abstract

In summary, while absolute proof of the mechanism of lacunar infarction is lacking in the majority of instance, the evidence gathered to date would suggest that in situ small vessel disease causing local vessel occlusion is the predominant mechanism, while the possibility cannot be excluded that, on rare occasions, emboli from the heart or large vessels are implicated.

In our study we studied the role of cerebral embolism in the pathogenesis of lacunar infarction using clinical assessment, cardiac evaluation (through TTE &lor TEE) and vascular evaluation (using CD & TCD) in search for possible embolic sources. We used conventional imaging techniques (CT & MRI) besides new one ofDWI to identify the duration and multiplicity of lesions.

It was found that hypertension and hypercholesterolemia present in high percentage in our studied patients, while other risk factors had no significant difference between the studied groups except for AF with high incidence in group II.

As regards cardiac assessment, there was a higher incidence of cardiac source of embolization in group II. Also, vascular evaluation using CD showed a significant number of patients with extracranial carotid artery disease, while TCD detected significant changes in both anterior and posterior circulation, moreover, impaired VMR detected by TCD was significantly higher in group I compared to group II, which is correlated to higher incidence of hypertension in this group.