Single and multiple cerebral infarctions caused by atherosclerosis: morphology and pathogenesis

In 139 cases of cerebral infarctions, caused by atherosclerosis, macro- and microscopic investigation of brain and its vascular system as well as heart examination were conducted. Infarctions were located in the anterior circulation in 68 cases, in the posterior circulation – in 36 cases, in both the anterior and posterior circulations – in 34 cases. Single extensive, large or medium cerebral infarction was found in 45 cases. In 93 cases there were multiple infarcts, located in the vertebrobasilar, carotid or both arterial territories. Infarctions in these cases were mainly small and medium. Number of cases with single and multiple infarcts in the anterior circulation were nearly the same, while infarcts in the posterior circulation were predominantly multiple. Main causes of either single or multiple infarctions in anterior circulation were obstructive atherothrombosis and cardiogenic thromboembolism, infarctions in posterior circulation were evoked by tandem atherostenosis and obstructive atherothrombosis of the brain arteries. It has been found that multiple infarctions within the one arterial territory mainly have the same mechanism of their occurrence. Infarctions of different subtypes were found more frequently when located in both the anterior and posterior circulations. The most frequent combination regardless of infarctions localization was combination of acute atherothrombotic infarct and old hemodynamic infarcts of smaller size.