Clinical, demographic and neuroradiological features of different types of cerebral border zone infarcts in North-west India

Background: Whether there are different pathogenic mechanisms for different types of cerebral border zone infarct is still not clear as most of previous studies had conflicting results. Furthermore there is no data available for Indian population. Objectives: To study the demographic, clinical and radiological profile of different types of border zone infarct (BZI) patients in North-west India. Methods: We prospectively analyzed 672 consecutive patients with ischemic stroke. Among them 86 border zone infarct patients were selected and further categorized as external border zone infarct (EBI), internal border zone infarct (IBI) and mixed border zone infarct (MBI) based on diffusion-weighted imaging characteristics. Baseline patient characteristics, clinical courses, and neuroradiological features were compared between different types. Results: We identified 31 patients with EBI, 21 with IBI and 34 with MBI. When compared with the EBI patients, IBI and MBI patients had significant middle cerebral or internal carotid artery stenosis (P-0.008). Concomitant small cortical infarcts were more seen with EBI. More patients in IBI group had early clinical deterioration and poor outcome at 1 month after stroke than in EBI group. Conclusions: IBI are mainly caused by hemodynamic compromise, whereas embolic mechanism responsible for the genesis of EBI. Patients with IBI had worse hospital course and poor outcome than EBI patients. Different therapeutic approaches may be required for different types of border-zone infarcts to improve outcome. (c) 2018 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.