The Cerebral Infarct : Pathology, Pathogenesis, and Computed Tomography

The aim of this book is to expand the clinical information given by computed tomograms (CTs) of cerebral infarcts. Anatomical sections are displayed parallel to the CT correlate in the hope that the interpretation of pathogenesis will provide valuable clinical data at a time when the number of angiographies performed in cerebrovascular cases has diminished rapidly. For better understanding of pathogenesis our concepts concerning the process of infarction have been summarized on the basis of schematic draw­ ings. K.-J. ZULCH KOln Acknowledgments I am most grateful to Professor Hoeffk:en for permission to use computed tomograms from his institution, to Herr GOldner and Frau Miihlhover for their technical assistance, and to Frau Goldner for help during the editorial work. My particular thanks go to my friend Professor W.S. Fields, Houston, who undertook the great burden of styling the English text. My gratitude is expressed to Dr. Dr. h.c. multo Heinz Gotze and Springer­ Verlag for the excellent layout and quality of this book.

I Cerebral Infarcts and Computed Tomograms.- 1 Introduction.- 2 Incidence of Cerebral Infarcts in a Series of Unselected Computed Cranial Tomograms.- 3 Concept of Cerebral Infarction.- 3.1 General Semiology of Infarction.- 3.2 The Hemorrhagic Type of Infarction.- 4 Technical Aspects of Interpreting Computed Tomograms.- 4.1 Time Course of the Changes in Density of the Tissue.- 4.2 Contrast Enhancement.- 4.3 The Fogging Effect.- 4.4 Increased Volume of the Tissue.- 4.5 Protein-Rich Edema.- 4.6 Improper Prognosis.- 4.7 Relating a Focal Lesion to a Transient Ischemic Attack.- 4.8 Flow Measurements.- II Correlations of CT Scan Patterns with Pathoanatomical Specimens.- III The Systematic Classification of Brain Infarcts.- 1 Carotid Territory.- 1.1 Superficial Infarcts in the Territory of the Middle Cerebral Artery.- 1.1.1 Infarcts of the Middle Cerebral Artery.- 1.1.1.1 Complete Infarct of the Middle Cerebral Artery Including the Striate and Anterior Choroidal Arteries.- 1.1.1.2 Infarct of the Middle Cerebral Artery Excluding the Striate Arteries.- 1.1.1.3 Infarct of the Middle Cerebral Artery, Anterior Third.- 1.1.1.4 Infarct of the Middle Cerebral Artery, Middle Third.- 1.1.1.5 Infarct of the Middle Cerebral Artery, Posterior Third.- 1.1.1.6 Four Special Types of Infarct Within the Territory of the Middle Cerebral Artery.- 1.1.1.7 Spotty Infarcts of the Territory of the Middle Cerebral Artery.- 1.1.1.8 Bilateral Infarcts of the Middle Cerebral Artery.- 1.1.1.9 Subcortical Infarct in the Territory of the Middle Cerebral Artery.- 1.1.2 Infarcts in the Anterior Cerebral Artery Territory.- 1.1.2.1 Infarcts of the Anterior Cerebral Artery, Anterior Division.- 1.1.2.2 Infarcts of the Anterior Cerebral Artery, Posterior Division.- 1.1.2.3 Total Infarction of the Anterior Cerebral Artery Territory.- 1.1.2.4 Spotty Infarcts in the Anterior Cerebral Artery Territory.- 1.1.2.5 Infarcts in the Territory of the Long Central Artery (Recurrent Artery of Heubner).- 1.1.3 Combined Infarcts.- 1.1.3.1 Combined Infarcts of the Anterior and Middle Cerebral Artery Territories.- 1.1.3.2 Combined Infarcts of the Middle and Posterior Cerebral Arteries.- 1.1.4 Total Infarcts of the Internal Carotid Artery Territory.- 1.2 Deep Infarcts in the Area of the Middle Cerebral Artery.- 1.2.1 Infarcts in Putamen and Head of Caudate Nucleus (Borderline Pattern).- 1.2.2 Total Infarcts of the Striatum.- 1.2.3 Terminal Infarcts in Putamen and/or Caudate Nucleus (Most Distant Field).- 1.2.4 Lacunar Infarcts.- 1.2.4.1 Lacunar Infarct in the Semioval Center.- 1.2.4.2 Lacunar Infarct in Thalamus.- 1.2.4.3 Lacunar Infarct in Putamen.- 1.2.4.4 Lacunar Infarct in Pons.- 1.2.4.5 Lacunar Infarct in Cerebellum.- 1.2.4.6 Lacunar Infarcts in the Territory of the Anterior Choroidal Artery.- 2 The Vertebrobasilar Circulation ― Infarcts in the Territory of the Vertebral and Basilar Arteries 58.- 2.1 Infarcts in the Territory of the Posterior Cerebral Artery.- 2.1.1 Infarcts of the Calcarine Artery (Medial Occipital Infarct).- 2.1.2 Infarcts of the Occipitotemporal Artery (Lateral Occipital Infarct).- 2.1.3 Cortical Infarcts Within the Area of the Posterior Cerebral Artery.- 2.1.4 Total Infarct of the Posterior Cerebral Artery.- Bilateral Infarcts of the Posterior Cerebral Arteries.- 2.1.6 Infarcts in the Center of the Territory of the Posterior Cerebral Artery.- 2.2 Infarcts in Thalamus (Thalamogeniculate and Thalamoperforate Arteries).- 2.3 Infarcts in Cerebellum.- 2.3.1 Dorsal Cerebellar Infarct (Superior Cerebellar Artery).- 2.3.2 Ventral Cerebellar Infarcts (Anterior Inferior Cerebellar Artery).- 2.3.3 Infarcts at the Watersheds (Border Zone) of the Cerebellar Arteries.- 2.3.4 Infarcts in the Pedunculi (Perforating Arteries, Unilateral or Bilateral).- 2.3.5 Infarcts of Pons (Paramedian Pontine Artery, Short and Long Circumflex Arteries).- 2.3.5.1 Infarct of the Paramedian Pontine Artery.- 2.3.5.2 Infarct of the Long Circumflex Pontine Artery.- 2.3.5.3 Infarcts of the Posterior Inferior Cerebellar Artery (Wallenberg’s Artery).- 3 The Watershed (Border Zone) Infarcts.- 3.1 Annular Infarcts.- 3.1.1 Annular Infarct of the Watersheds, Anterior Part.- 3.1.2 Annular Infarct of the Watersheds, Posterior Part.- 3.1.3 Three-Territory Border Infarct (Dreiländereck-Infarkt).- 4 The Multiinfarct Brain.- 5 Atrophic Processes: Ischemic Atrophies.- Addendum.- References.- Name Index.