From the Guidelines
Basal ganglia infarcts typically present with contralateral hemiparesis, hemianesthesia, and sometimes hemianopia, with the specific symptoms depending on which part of the basal ganglia is affected. The clinical presentations of a basal ganglia infarct can vary widely, but generally include motor deficits, sensory changes, and potentially cognitive and behavioral alterations. Patients may develop movement disorders such as chorea, dystonia, or parkinsonism features, as well as cognitive and behavioral changes, including apathy, decreased motivation, and executive dysfunction 1.
When considering the specific areas of the basal ganglia affected, infarcts in the caudate nucleus can cause behavioral changes and abulia (reduced spontaneous movement and speech), while putamen infarcts often result in motor deficits. Globus pallidus infarcts may cause dystonia or parkinsonism. The dominant hemisphere being affected can lead to language deficits like aphasia.
Diagnosis of basal ganglia infarcts requires brain imaging, with MRI being more sensitive than CT for detecting small infarcts, as indicated by the systematic review of cerebrovascular disorders and basal ganglia cerebrovascular disease 1. Management follows standard stroke protocols, including acute interventions if within the treatment window, such as thrombolysis with tPA or thrombectomy for eligible patients, followed by secondary prevention with antiplatelet therapy, statins, blood pressure control, and lifestyle modifications.
Key aspects of management include:
- Early initiation of rehabilitation focusing on physical, occupational, and speech therapy to maximize functional recovery
- Antiplatelet therapy, typically with aspirin 81-325mg daily, clopidogrel 75mg daily, or combination therapy
- Statin use for lipid management
- Blood pressure control to prevent further vascular events
- Lifestyle modifications, including diet, exercise, and smoking cessation, to reduce stroke risk factors.
From the Research
Clinical Presentations of Basal Ganglia Infarct
The clinical presentations of basal ganglia infarct can vary, but some common features include:
- Hemiparesis, as seen in a 2-year-old boy who presented with right-side hemiparesis after a trivial fall 2
- Facial-brachial-crural hemiparesis, which is typical of basal ganglia stroke and usually regresses after a period ranging from several weeks to several months 3
- Cognitive impairment, as basal ganglia stroke is associated with an increased risk of cognitive impairment 4
- Altered functional connectivity of the left inferior temporal gyrus, which may be involved in neural plasticity after ischemic stroke 4
Associated Factors and Management
Some associated factors and management strategies for basal ganglia infarct include:
- Vasospasm of the lenticulostriate arteries, which can cause ischemia of the basal ganglia as an immediate consequence of minor head injury in children 3
- Emboligen heart disease, thrombophilia, and acute traumatic arterial dissections, which should be excluded by instrumental and laboratory studies 3
- Conservative management with osmotic diuretics to reduce perilesional edema, which appears to be the most effective therapeutic approach 3
- Surgical treatments, such as neuroendoscopic surgery, which may be relatively beneficial for basal ganglia hemorrhage treatment, but have their own indications 5