Acute Multiple Brain Infarcts Research Articles

“MRI IN ASSESSMENT OF SINGLE AND MULTIPLE ARTERIAL TERRITORY ACUTE BRAIN INFARCTS”

Background &Method: Aim of this study was to study the role of MRI in assessment of single and multiple arterial territory acute brain infarcts. Patients referred to department of radiology from various in and out-patient departments of our hospital with signs and symptoms of acute stroke were considered for study. These patients were taken for MRI brain using standard imaging protocols. After explaining the details of the research and taking the proper consents, the relevant clinical data was collected. The ndings were carefully observed under local expertise and relevant observations were made, followed by careful and detailed statistical analysis and calculations. Males suffer from acute arterial infarcts Result: more than females. Among modiable risk factors hypertension is the most common. In the anterior circulation acute MCA is the most common artery involved. Bilateral acute infarcts are more common in posterior circulation and PCA is the most common artery involved. With addition of DWI the diagnosis of acute infarcts could be made more correctly and chances of errors decreases. In my study maximum patients Conclusion: were in age group 51-60 years followed by 61-70 years. The number of male patients was 62% and female patient was 38%. Hypertension was the most common risk factor. Anterior circulation acute infarcts were more as compared to posterior circulation and MCA were most commonly involved. The major territory of involvement in the posterior circulation was the PCA followed by PICA. Bilateral infarcts were more common in the posterior circulation.16 patients had AMBI (acute multiple brain infarcts). Among these patients bilateral hemispheric involvement was more common. AMBI were more common in the posterior circulation. The sensitivity of DWI was 99% as compared to conventional MRI sequences, the sensitivity of which was around 90%

Clinical Characteristics and Analysis of Lung Cancer- Associated Acute Ischemic Stroke

IntroductionThe incidence of lung cancer and acute ischemic stroke remains high in recent years, both of which occur mostly in people over 60 years old. In the present study, we aimed to further clarify the pathogenesis of lung cancer-associated acute ischemic stroke (LCA-AIS) by comparing and analyzing clinical characteristics of stroke patients with or without lung cancer. MethodsA total of 51 patients with lung cancer were selected as the case group (LCSG), and 78 patients without cancer history were adopted as the control group (SG). The data collected in this study included sex, age, traditional cerebrovascular disease risk factors (TCDRFs), blood test index, imaging findings, etiological typing, and prognosis evaluation. SPSS21.0 software was used for statistical analysis. Normally distributed data were analyzed by t-test, and count data were analyzed by chi-square test or exact probability method. P < 0.05 was considered statistically significant. ResultsIn the case group, the levels of plasma D-dimer, fibrinogen degradation products (FDPs) and NIHSS, as well as the mRS score and mortality of patients, were higher, while the levels of RBC, Hb and Hcy were lower compared with the control group. Imaging findings showed that multivessel involvement was more common in the case group, and the infarcts were more likely to be multiple and involved in both the anterior and posterior circulations. The TOAST classification of LCSG was dominated by stroke of undetermined etiology (SUE) and stroke of other determined etiology (SOE). Statistical analysis showed that the patients were more likely to suffer from acute ischemic stroke within 1 year after the diagnosis of lung cancer (41 cases, 80.39%). ConclusionsHypercoagulability and acute multiple brain infarcts were more common in patients with LCA-AIS, and hypoproteinemia and hyponatremia were more likely to occur in these patients, leading to worse prognosis. Patients were most likely to have a stroke within 1 year after the diagnosis of lung cancer.

D-dimer >2.785 μg/ml and multiple infarcts ≥3 vascular territories are two characteristics of identifying cancer-associated ischemic stroke patients

ABSTRACTBackground: The patterns and mechanisms underlying stroke in cancer patients differ from those of the conventional etiology. In this study, we further investigated the characteristics distinguishing cancer-associated ischemic stroke (CAIS) and the relationship of D-dimer value with CAIS.Methods: Sixty-one acute ischemic stroke patients with cancer (cancer group) and 76 stroke patients without cancer (control group) were recruited. Cerebrovascular distribution was divided into 3 circulations and 23 vascular territories, and acute multiple brain infarcts (AMBIs) were defined as discrete MRI diffusion-weighted imaging (DWI) lesions in >1 vascular territory.Results: Cancer patients had higher average D-dimer and fibrinogen degradation product values, and fewer stroke risk factors. The numbers of infarct-affected vascular territories, AMBIs, and AMBIs in multiple circulations were significantly higher in the cancer group. Receiver operating characteristic analysis showed that the cutoff value of D-dimer was 2.785 μg/ml; and above features were particularly evident in cancer patients whose D-dimer values were >2.785 μg/ml, while those with D-dimer values ≤2.785 μg/ml were similar to controls.Conclusions: D-dimer >2.785 μg/ml may be an effective cutoff value and a sensitive index for identifying CAIS patients. AMBIs in ≥3 vascular territories and AMBIs in both the anterior and posterior circulations are two imaging characteristics of CAIS.

Multidetector Computed Tomography Angiography to Detect the Cause of Multiple Brain Infarctions

Multidetector computed tomography angiography (MDCTA) is useful to inspect cardiovascular pathologic changes with minimal invasiveness. Here we evaluated the usefulness of MDCTA to determine the cause of acute multiple brain infarction (AMBI). AMBI was defined as multiple recent infarcts demonstrated on diffusion-weighted imaging. A new infarction within 2 weeks from the last was also considered an AMBI. Between January 2012 and December 2013, 967 patients were diagnosed with acute brain infarction and 138 (14.3%) with AMBI. Among them, 57 (39 men and 18 women; age, 38-93 years) were examined by MDCTA using the dual-phase method. All images were diagnostic, even if patients found it difficult to hold their breath. Fifteen patients (26.3%) were diagnosed with patent foramen ovale (PFO). Two had complications of atrial fibrillation (AF), necessitating anticoagulant therapy (ACT). Four had both PFO and severe aortic atherosclerotic plaque formation, necessitating single antiplatelet therapy (APT) and/or ACT. Fifteen patients (26.3%) developed complicated arterial plaques around the aortic arch and were administered single or dual APT and/or ACT, except 1 patient with a history of multiple cerebral bleeding. Nine patients had pre-existing AF. Furthermore, ACT was initiated for 2 other patients with thrombus or circulatory stasis in the left atrial appendage despite normal electrocardiographic findings. Two other patients were diagnosed with advanced cancer, which was considered Trousseau syndrome. The cause of AMBI was determined in 36 (63.2%) patients. MDCTA is a useful and less invasive method to identify the cause of embolic infarction.

Acute multiple brain infarction in large-artery atherosclerosis is associated with hyperhomocyst(e)inemia

Although hyperhomocyst(e)inemia had been proven to be a potent risk factor for ischemic stroke, it is still controversial which subtype of stroke is associated with hyperhomocyst(e)inemia. The aim of this study was to clarify the association between plasma homocyst(e)ine (Hcy) levels and stroke subtypes according to TOAST classifications based on MRI findings. We prospectively recruited 124 consecutive first-ever ischemic stroke patients hospitalized in Toride Kyodo General Hospital. Each patient underwent brain MRI including diffusion-weighted imaging (DWI) and was evaluated for total plasma Hcy levels in addition to routine laboratory tests. Of the 93 patients enrolled in this study, 19 were subtyped with large-artery atherosclerosis with acute multiple brain infarction [LA-AMBI(+)], 13 with LA-AMBI(-). Patients with LA-AMBI(+) showed significantly higher plasma Hcy levels than those with LA-AMBI(-). Moreover, for LA-AMBI, the plasma Hcy level was associated with an OR of 1.3 (95% CI 1.06-1.71, P=0.017) per 1 mumol increase in concentration, and 1.4 (95% CI 1.04-1.77, P=0.025) after adjustment for age, sex and serum cholesterol levels. In the subset of patients with LA strokes, those with high Hcy levels are more likely to have AMBI than those without elevated Hcy levels possibly due to plaque instability.

Diffusion-Weighted Magnetic Resonance Imaging in Symptomatic Vertebrobasilar Atherosclerosis and Dissection

Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail. To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia. Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease. Large community-based teaching hospital. Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset. Infarct patterns were analyzed according to established templates of vascular territories. Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P = .48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P = .09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (37%) of 11 patients with dissections (P = .6). Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.

Diffusion-weighted magnetic resonance imaging in internal carotid artery dissection.

Acute multiple brain infarction pattern on diffusion-weighted imaging is associated with arterial or cardiac sources of embolism. To review the diffusion-weighted imaging characteristics of patients with strokes secondary to internal carotid artery (ICA) dissection and to gain further insights into the mechanisms of cerebral ischemia. Patients with ICA dissection and ischemic stroke were identified by review of an angiographic database and hospital discharge codes. Patients were included if the diagnosis of ICA dissection was confirmed and diffusion-weighted imaging was obtained within 10 days of symptom onset. Infarct patterns were analyzed according to established templates of vascular territories. Inclusion criteria were met by 14 patients. Internal carotid artery occlusion was present in 10. Acute multiple brain infarction was found in 10 (71%) of the 14 patients. Cortical involvement was found in 8 patients, while the infarct was restricted to the subcortical region in 6. In 9 (64%) of the 14 patients, ischemic lesions were located in 1 of the 3 border zones. Acute multiple brain infarction pattern with border zone involvement is frequently found in ICA dissection-related strokes. This finding may further support an interaction of hemodynamic and embolic mechanisms as a cause of cerebral ischemia in this condition.

Significance of acute multiple brain infarction on diffusion-weighted imaging.

Diffusion-weighted imaging (DWI) is superior to conventional MRI in identification of small new ischemic lesions and discrimination of recent infarcts from old ones. Thus, this technique is useful in the detection of acute multiple brain infarcts (AMBI). We sought to determine the frequency and the topographical and etiologic patterns of AMBI detected on DWI. We studied 329 consecutive ischemic stroke patients who underwent DWI and MRI/MR angiography within 4 days of stroke onset. AMBI was defined as noncontiguous high signal intensities on DWI in >1 vascular territory. Stroke mechanism was determined according to the criteria of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). We detected AMBI in 95 patients (28.9%). AMBI in anterior circulation was found in 62 cases: in 1 hemisphere in 42 (group A) and in bilateral hemispheres in 20 (group B). Twenty-two patients had AMBI in the posterior circulation (group C) and 11 in both anterior and posterior circulations (group D). The most frequent cause of stroke was large-artery atherosclerosis in groups A (33/42), B (9/20), and C (15/22) (P=0.02) and cardioembolism in group D (6/11) (P=0.02). Elevated fibrinogen or hematocrit was significantly associated with group B (P=0.01). In 9 patients in groups B and D, anatomic variations of anterior or posterior cerebral arteries or patent posterior communicating artery contributed to AMBI. Different topographical patterns of AMBI are associated with different vascular pathologies and stroke mechanisms. Hemorheologic abnormality or vascular anatomic variations may be contributing factors in the pathogenesis of AMBI in bilateral cerebral hemispheres or in both anterior and posterior circulations.