Is a lacunar infarct of the body of the right caudate nucleus a cortical or subcortical infarct?

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From the Guidelines

A lacuna infarct of the body of the right caudate nucleus is subcortical. The caudate nucleus is a deep brain structure that forms part of the basal ganglia, which are located beneath the cerebral cortex within the white matter of the brain. Subcortical structures include the basal ganglia (caudate nucleus, putamen, globus pallidus), thalamus, and internal capsule. These structures are distinct from the cerebral cortex, which forms the outer layer of the brain. According to the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack by the American Heart Association/American Stroke Association 1, lacunar stroke is defined as a lacunar syndrome with normal computed tomography (CT)/magnetic resonance imaging (MRI) or subcortical stroke measuring <1.5 cm in diameter on CT or MRI.

Key characteristics of lacunar infarcts include:

  • Small size, typically less than 15mm in diameter
  • Occurrence due to occlusion of small penetrating arteries that supply deep brain regions
  • Common involvement of subcortical structures
  • Potential to cause various neurological deficits depending on the precise location of the infarct

In the context of the caudate nucleus, which plays important roles in motor control, learning, memory, and emotion, damage from a lacuna infarct may result in movement disorders, cognitive changes, or behavioral alterations. The definition provided by the American Heart Association/American Stroke Association 1 supports the classification of a lacuna infarct in the body of the right caudate nucleus as subcortical, given its location and the nature of lacunar strokes.

From the Research

Location of Lacuna Infarct

  • A lacuna infarct is characterized as a small subcortical infarct, as stated in the study 2.
  • The term lacuna refers to a well-defined, subcortical ischemic lesion at the level of a single perforating artery, as described in the study 3.

Caudate Nucleus Infarcts

  • Caudate nucleus infarcts are typically subcortical, as they occur in the deep structures of the brain, as reported in the study 4.
  • A lacuna infarct in the body of the right caudate nucleus would therefore be classified as subcortical, based on its location in the deep structures of the brain.

Subcortical Infarcts

  • Subcortical infarcts, including lacunar infarcts, are caused by disease in small perforating arteries, as explained in the study 3.
  • These infarcts are typically small and deep, and can occur in various locations, including the caudate nucleus, as described in the study 4.
  • The study 2 also notes that lacunar infarcts are often associated with small vessel disease, which affects the deep structures of the brain.

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