Calcified Carotid Plaque - Source of Emboli
Calcified carotid plaques can serve as an embolic source in acute stroke. Although considered more stable than atheromateous plaque, their rupture could lead to vascular occlusion. Given their calcified nature, they are refractory to IV thrombolysis and their retrieval using interventional techniques is more challenging. Given their solid nature, it would not incorporate as a traditional cloth would within the stent retriever and can get be pushed against the intimal wall as the stent opens.
Cortical laminar necrosis is the death of cells in the cortex of the brain in a band-like pattern, with a relative preservation of cells immediately adjacent to the meninges.
The difference can be seen as a consequence of the neurons within the cortex being far more metabolically active than glial cells or adjacent white matter.
It is a finding that can be seen in late subacute to chronic stroke.
A watershed stroke or watershed infarct is defined as a brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries. The actual blood stream blockage/restriction site can be located far away from the infarcts.
Severe reduction of perfusion secondary to severe left carotid stenosis was responsible in this case.
Striatocapsular infarcts involve the striatum (ie the caudate nucleus and putamen), without involvement of the cortex secondary to either a complete or partial proximal MCA occlusion limiting flow to the lenticulostriate arteries.
Classically patients exhibit both cortical (e.g. aphasia, sensory neglect or extinction, apraxia) and subcortical (e.g. upper limb hemiparesis, dysarthria) neurological signs.