Elnan Kvistad CE, Oygarden H, Logallo N, Moen G, Thomassen L, Waje-Andreassen U, and Naess H. A Dark Side of Subcortical Diffusion-Weighted Lesions? Characteristics, Cause, and Outcome in Large Subcortical Infarction: The Bergen Norwegian Stroke Cooperation Study. Stroke. 2014
While we have all read plenty about small vessel disease infarcts or lacunar infarcts, less has been said about large subcortical infarcts (LSI) that can be colloquially referred to as lagoons. In this study the authors aimed to identify the differences in clinical characteristics, etiologic factors and outcome amongst patients with LSI when compared with lacunar infarcts (LI), cortical infarcts (CI) or infarcts elsewhere (no LSI).
This study highlights how a large subcortical infarct may initially “look like a duck” but “not quack like one”. Clinically a LSI may appear to mimic a lacunar syndrome; however there is a higher likelihood for progression of symptoms and presence of a large vessel occlusion. These characteristics underscore the importance for early treatment with IV tpa and need for diffusion weighted imaging. Although a large proportion of these patients had unclear mechanism of stroke, I would have liked to know more about the extent of stroke workup that these patients were subjected to. Also, were the raters of clinical symptoms and MRI findings independent? If not, there definitely could have been introduction of bias. As one would have expected with a larger stroke size, these patients had worse short term outcome. But, how about long term outcome? I hope to see more literature in the near to help answer some of these questions.