Clinical Characteristics of Borderzone Infarction in Egyptian Population Nevine El Nahas, MD, PhD,* Hossam Shokri, MD, PhD,* ,1 Osama Abdulghani, MD, PhD,* Magd Zakaria, MD, PhD,* Taha Kamel, MD, PhD,* Nagia Fahmi, MD, PhD,* Naglaa Khayat, MD, PhD,* Aly Shalash, MD, PhD,* Ahmed El Basiony, MD, PhD,* Ramez Reda, MD, PhD,* Sherine Farag, MD, PhD,* Mohamed Tork, MD, PhD,* Ahmed Elbokl, MD, PhD,* Ihab Abdelbaset, Msc,† and Hany Aref, MD, PhD* Objectives: In this research we wanted to highlight the importance of defining Border- zone infarctions (BZI) as a separate subtype in stroke classifications. We thus studied cases of isolated BZI, small vessel disease (SVD), and large vessel disease (LVD), to identify their points of similarities and difference in a sample of Egyptian patients. Methods: This is a cross-sectional (observational) study. Consecutive 637 acute ische- mic stroke patients were recruited over a 2 year period, from 2 stroke units of Ain Shams University hospitals in Egypt. Medical history and laboratory investigations were done to identify risk factors. National Institute of Health Stroke Scale (NIHSS) was performed on admission, and modified Rankin scale (mRS) on admission, and after 3 months. MRI brain was done to identify stroke subtype; MRA and carotid duplex were used to define vascular status. Results: Among the studied group of patients, 72 (11.3%) had BZI, 145 (22.8%) had SVD, 165 (26%) had LVD, and 255 were excluded as they had either undetermined, or mixed etiology. BZI showed signifi- cantly older age, early confluent lesions, more disease severity by NIHSS, and worst outcome by mRS (P < 0.05). SVD had more microbleeds than BZI and LVD. LVD showed lower prevalence of hypertension and lower high-density lipoprotein levels. Conclusions: Isolated BZI, SVD, and LVD infarctions have characteristic risk factors and clinical patterns. Further studies are needed to identify if they are different from cases with mixed pathology. This could have an impact on the selection of primary and secondary preventive measures appropriate to each type. Key Word: All clinical neurology—all cerebrovascular disease/stroke— borderzone Infarction—small vessel disease—large vessel disease © 2019 Elsevier Inc. All rights reserved. Introduction Borderzone infarctions (BZI) have been reported to repre- sent 10%-12.7% of ischemic strokes. 1,2 However, their preva- lence might be under estimated as they are not included in the Trial of Org 10172 in Acute Stroke Treatment classifica- tion 3 among different stroke subtypes. BZI might be, mistakenly, labeled as large vessel disease (LVD) when MRI shows white matter lesions and greater than 50% intra-cra- nial or extra-cranial arterial stenosis, or as small vessel dis- ease (SVD) based on MRI picture of deep white matter hyperintense lesions in the absence of vascular stenosis. BZI might present with transient ischemic attacks (TIAs) and probably those patients do not ask for medical advice. 1 From the *Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; and †Department of Neurology, Kafr Alshiekh General Hospital, Kafr Alshiekh, Egypt. Received November 10, 2018; accepted January 6, 2019. Financial Disclosures: The authors Report no disclosures. Study Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Address correspondence to Nevine M. El Nahas, MD, PhD, Depart- ment of Neurology, Faculty of Medicine, Ain Shams University, Abba- sia Square, Cairo, Egypt. E-mailes: nevineelnahas30@yahoo.com, nevine_elnahas@med.asu.edu.eg. 1 Statistical Analysis conducted by Dr. Hossam Shokri, MD, PhD, Ain Shams University, Neurology Department. 1052-3057/$ - see front matter © 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.003 Journal of Stroke and Cerebrovascular Diseases, Vol. &&, No. && (&&), 2019: &&À&& 1 ARTICLE IN PRESS