Recurrent Cerebral Infarction Research Articles

Clinical characteristics of heavy alcohol consumption in young and middle-aged acute cerebral infarction: A 12-month follow-up study

ObjectiveTo investigate the clinical characteristics and prognosis of heavy alcohol consumption among young and middle-aged patients with acute cerebral infarction (ACI). MethodsA total of 263 young and middle-aged ACI patients were included in the study from June 2018 to December 2020 and classified into heavy drinkers and non-heavy drinkers. Multivariate logistic regression analysis was conducted to assess the association between ACI and heavy alcohol consumption, considering clinical characteristics and one-year post-discharge prognosis. ResultsAmong the patients, 78 were heavy drinkers. Heavy drinkers were more likely to consume alcohol 24 h before ACI onset (OR 4.03, 95 % CI 2.26–7.20), especially in the form of liquor (OR 3.83, 95 % CI 1.59–9.20), and had a higher risk of diastolic blood pressure ≥90 mmHg upon admission (OR 2.02, 95 % CI 1.12–3.64). In the one-year post-discharge prognosis, heavy drinkers had a greater likelihood of poor prognosis at 3 months (OR 2.31, 95 % CI 1.01–5.25), were less likely to quit drinking after discharge (OR 0.36, 95 % CI 0.19–0.66), and had a higher risk of recurrent cerebral infarction (OR 2.79, 95 % CI 1.14–6.84). ConclusionsOver the 12-month follow-up, young and middle-aged ACI patients with heavy alcohol consumption exhibited worse short-term prognosis. Controlling alcohol consumption levels may improve the prognosis of these patients.

Mối liên quan giữa lâm sàng và hình ảnh học của nhồi máu não tái phát do tổn thương động mạch não giữa

Objectives: Evaluate the relationship between clinical and imaging of recurrent cerebral infarction dued to MCA damaged. Subjects and method: A cross-sectional, descriptive study of 77 patients with recurrent cerebral infarction dued to damaged middle cerebral artery treated at the Neurological Center, Bach Mai Hospital from July 2021 to August 2022. Results: Motor paralysis of the hemibody on the opposite side of the injury, paralysis of the central VII nerve on the opposite side of the injury and decreased sensation of the hemibody on the opposite side of the injury are symptoms seen at a high rate, accounting for 100% respectively; 90.9% and 77.9%. The proportion of patients with consciousness disorders from the beginning accounted for 49.4% of patients, 2 patients were in a deep coma when hospitalized (accounting for 2.6%). Language disorders including Broca’s language disorder, Wernicke’s language disorder and mixed language disorder accounted for 20/77 patients (26.0%). Horizontal eye and head deviation, circular muscle disorders, loss of attention on one side of the body, and hemianopia account for 32.5% respectively; 26.0%; 22.1%; 26.0%. 7.8% of patients had mental disorders and 14.3% of patients had seizures when hospitalized; The symptoms of headache, nausea, and vomiting accounted for 45.5% and 31.2%, respectively. Patients with symptoms clustered into Gerstman syndrome and Anton - Babinski syndrome account for a low rate: 9.1% and 11.7%. The most damaged arterial branch is the M1 branch with 31 patients, accounting for 40.2%; Oblique branches of the middle cerebral artery or putamen-striatum branches account for 32.5%. Only 4 patients had damage to branches M3 - M4 (accounting for 5.2%). The number of patients with damage to the M1 branch who had consciousness disorders accounted for the highest rate of 33.8%, with no patients with damage to the deep branch having consciousness disorders. Symptoms at hospital admission: consciousness disorders, speech disorders, turning eyes and head to the damaged hemisphere have a statistically significant relationship with the location of the damaged middle cerebral artery branch (p < 0.05)Conclusion: Recurrent cerebral infarction due to damage to the middle cerebral artery has diverse clinical symptoms, depending on the damaged middle cerebral artery branch.

Efficacy and safety of 3-month dual antiplatelet therapy in patients after mechanical thrombectomy for acute ischemic stroke: a retrospective study.

Mechanical thrombectomy (MT) is one of the effective treatment methods for acute ischemic stroke (AIS), which requires a period of dual antiplatelet therapy (DAPT) after endovascular treatment. This study aimed to compare the efficacy and safety of 3-month DAPT and 1-month DAPT in AIS patients receiving MT through a retrospective study. AIS patients who received MT from May 2018 to March 2023 were grouped into a 1-month group (1-M group) and a 3-month group (3-M group) according to the duration of DAPT after MT. The primary outcome was the mRS score at 90 days. Secondary outcomes included a good prognosis (mRS score of 0-2) at 90 days post-surgery, 6-month mortality, recurrence of cerebral infarction, Barthel's index, Montreal Cognitive Assessment (MoCA) score, and incidence of symptomatic intracranial hemorrhage (sICH) during hospitalization. A total of 147 patients with AIS were included in the final analysis, with 78 patients in the 1-M group and 69 patients in the 3-M group. The baseline and neurological characteristics were comparable between both groups. At 3-month follow-up, a total of 61 patients had an mRS of 0-2 at 90 days, with an average mRS of 3.3 ± 0.9 for all patients. There was no statistically significant difference in the mRS between the two groups of patients at 90 days (P > 0.05). There was no statistically significant difference in the mortality rate and incidence of sICH between the two groups of patients during the 6-month follow-up period (P > 0.05), but the recurrence rate of AIS in the 3-M group was lower than that in the 1-M group (P < 0.05). The improvement of Barthel index and MoCA in patients in the 3-M group was higher than those in the 1-M group at 6 months but not statistically different (P > 0.05). For AIS patients undergoing mechanical thrombectomy, compared to 1-month DAPT, 3-month DAPT can reduce the recurrence rate of IS during a 6-month follow-up period, without increasing the mortality and risk of cerebral hemorrhage.

Unveiling the antecedent configurations of cerebral infarction recurrence using qualitative comparative analysis

BackgroundIschemic stroke is characterized by high incidence, high disability rate, and high recurrence rate. Stroke recurrence is a complex pathological phenomenon involving multiple factors. Logistic regression analysis is widely used in traditional medical statistical analysis. However, this method mainly investigates the net effect of single factors using large sample sizes. The fsQCA method is a more suitable means of analyzing the configuration effect of risk factors affecting cerebral infarction recurrence, because it is based on holism and considers interaction effects among the risk factors. ObjectiveThe purpose of this study was to explore the risk factors of cerebral infarction recurrence using fsQCA, to reveal the configurations that resulted in cerebral infarction recurrence, and to provide novel ideas for the prevention of recurrence. MethodsA total of 155 cerebral infarction patients admitted to the Department of Neurology of a tertiary class hospital in Shandong province from June 2020 to June 2021 were selected to participate. The demographic characteristics and risk factors associated with recurrence of cerebral infarction were collected, and participants were followed for one year. ResultsThe comparative analysis was performed by fuzzy-set (fsQCA 3.0) software. We conducted a configuration analysis of the risk factors of cerebral infarction recurrence and generated eight different configurations by analyzing various combinations of eight risk factors. ConclusionThis study presented results different from those reported in studies using linear regression models. It took into consideration the configurational effect of each conditional variable on cerebral infarction recurrence. To prevent such recurrences, medical workers should evaluate the combination of multiple influencing factors, instead of focusing on a single factor.

Influence of cerebral small vessel disease on functional outcome and recurrence of cerebral infarction in patients with type 2 diabetes

Influence of cerebral small vessel disease on functional outcome and recurrence of cerebral infarction in patients with type 2 diabetes

Percutaneous transluminal angioplasty for persistent primitive hypoglossal artery stenosis: illustrative case.

We report a case of symptomatic, progressive stenosis of a persistent primitive hypoglossal artery (PPHA), which was successfully treated with percutaneous transluminal angioplasty (PTA) of the origin of the PPHA. The PPHA is a type of carotid-basilar anastomosis with an incidence of 0.02% to 0.10%. It originates from the internal carotid artery (ICA), passes through the hypoglossal canal, and merges with the basilar artery. In many cases, the ipsilateral vertebral artery is hypoplastic; therefore, PPHA stenosis causes cerebral infarction in the posterior circulation territory, as in this case. The patient's right PPHA had severe and progressive stenosis; therefore, he experienced cerebral infarction despite medical treatment. Therefore, PTA for the stenosis was performed, which ceased the recurrence of cerebral infarction and dizziness by improving blood flow in the posterior circulation. Several reports have described ICA stenosis accompanied by PPHA or PPHA stenosis in patients receiving endovascular treatments. Almost all cases were nonprogressive, and the treatment procedure was stenting. However, in our case, the PPHA stenosis was progressive, and we performed PTA because the patient experienced resistance to antiplatelet drugs and had poor collateral flow.

The case of treatment for carotid web - Double-layer micromesh stent implantation in our hospital.

A carotid web is a shelf-like structure on the posterior wall of the origin of the internal carotid artery, and it is believed to cause cerebral infarction due to thrombus formed by turbulent flow with stagnation of blood flow. Recently, it has been suggested that recurrent cerebral infarction cannot be prevented in patients with a symptomatic carotid web by conventional medical management alone. However, there is still no consensus on the treatment of carotid webs. Carotid artery stenting (CAS) with the CASPER stent (Microvention, Terumo, Tustin, CA, USA) was performed in six consecutive patients with symptomatic carotid webs, and the results are reported along with a review of the literature. Six consecutive patients with a diagnosis of internal carotid artery stenosis due to a carotid web on magnetic resonance imaging and digital subtraction angiography (DSA) were included in this study. All patients underwent dual antiplatelet therapy approximately 10 days before surgery and after 6 months, and then, a CASPER stent was implanted under general anesthesia. All patients were evaluated postoperatively by DSA 6 months after treatment. In all patients, no in-stent stenosis was seen 6 months after the operation, and no symptomatic cerebral infarction occurred within 1 year after the procedure. CASPER stent implantation may be effective for treating carotid webs.

Clinical and radiological predictive factors of silent AF in ESUS stroke

A quarter of cerebral infarctions remain without etiology (ESUS: embolic stroke of unknown source) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The efficacy of the probabilistic anticoagulation strategy has not been demonstrated in this population making it necessary to identify ESUS patients at high risk of subclinical AF. The aim of this study is to determine clinical and radiological predictive factors of silent AF in ESUS stroke. Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included. In our study 42/300 (14%) patients had at least one episode of AF (> 30 s). In univariate analysis, the variables significantly associated with slower AF in ESUS-type stroke were age greater than or equal to 60 years (P = 0.004, OR = 3.76), female gender (P = 0.045, OR = 1.94), coronary artery disease (P = 0.008, OR = 3.43), previous stroke (P = 0.007, OR = 2.67), stroke of different territory or age (P = 0.031, OR = 2.65), stroke on awakening (P < 10−3, OR = 5.95), higher NIHSS score on admission (P = 0.023, OR = 1.08), lower NIHSS score on discharge (P = 0.031, OR = 0.89), older cerebellar stroke (P < 10−3, OR = 14.16). In multivariate analysis, higher NIHSS score at admission (P = 0.023, OR = 1.08), and lower NIHSS score (P = 0.031, OR = 0.89) at discharge appeared as independent predictors of the occurrence of a subclinical AF episode. In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. The subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing recurrent cerebral infarction. A therapeutic trial should confirm this hypothesis.

Long-term outcomes and quantitative radiologic analysis of extracranial–intracranial bypass for hemodynamically compromised chronic large artery occlusive disease

This study aimed to demonstrate the effectiveness of nonemergent extracranial-to-intracranial bypass (EIB) in symptomatic chronic large artery atherosclerotic stenosis or occlusive disease (LAA) through quantitative analysis of computed tomography perfusion (CTP) parameters using RAPID software. We retrospectively analyzed 86 patients who underwent nonemergent EIB due to symptomatic chronic LAA. CTP data obtained preoperatively, immediately postoperatively (PostOp0), and 6 months postoperatively (PostOp6M) after EIB were quantitatively analyzed through RAPID software, and their association with intraoperative bypass flow (BF) was assessed. The clinical outcomes, including neurologic state, incidence of recurrent infarction and complications, were also analyzed. The time-to-maximum (Tmax) > 8 s, > 6 s and > 4 s volumes decreased significantly at PostOp0 and up through PostOp6M (preoperative, 5, 51, and 223 ml (median), respectively; PostOp0, 0, 20.25, and 143 ml, respectively; PostOp6M, 0, 7.5, and 148.5 ml, respectively; p < 0.001, p < 0.001, and p < 0.001, respectively). The postoperative improvement in the Tmax > 6 s and > 4 s volumes was significantly correlated with the BF at PostOp0 and PostOp6M (PostOp0, r = 0.367 (p = 0.001) and r = 0.275 (p = 0.015), respectively; PostOp6M r = 0.511 (p < 0.001) and r = 0.391 (p = 0.001), respectively). The incidence of recurrent cerebral infarction was 4.7%, and there were no major complications that produced permanent neurological impairment. Nonemergent EIB under strict operation indications can be a feasible treatment for symptomatic, hemodynamically compromised LAA patients.

Transcatheter closure in a patient with atrial septal dissection and recurrent cerebral infarction

房间隔夹层是一种罕见疾病，多为心脏介入治疗及外科术后并发症，胸部钝性创伤所致者较少。临床表现因夹层大小、部位、腔内有无血栓形成及夹层是否破裂而不同，轻者可无任何症状，重者可出现脑梗死、心力衰竭等。该文报道1例中年女性不明原因反复脑梗死，最终确诊为房间隔夹层并行夹层介入封堵术，旨在提高对该病的认识。.

Mitral Valve Replacement for Enlarged Libman-Sacks Endocarditis in a Patient with Persistent Primary Antiphospholipid Syndrome and Recurrent Stroke: A Case Report.

BACKGROUND Anticardiolipin antibodies in patients with Libman-Sacks endocarditis (LS) are indicative of comorbid antiphospholipid syndrome (APS) and can result in cerebral infarctions. We describe a case of LS and primary APS with recurrent cerebral infarctions despite anticoagulation treatment. The patient underwent surgery for enlarged LS vegetation with high titers of antiphospholipid antibodies. CASE REPORT A 41-year-old Japanese man was admitted to hospital for small cerebral infarction recurrence in a left parietal lesion. At age 35, the patient had suffered multiple cerebral infarctions. He was found to have high serum titers of all 3 antiphospholipid antibodies. Transesophageal echocardiography (TEE) findings were normal. Differential diagnosis ruled out other autoimmune diseases and a clinical diagnosis of primary APS was made. Warfarin anticoagulation was started. When cerebral infarction recurred 6 years after the first episode, serum titers of antiphospholipid antibodies remained high, and TEE showed a 7×8 mm area of mitral vegetation. A TEE results from his first admission revealed a 5×6 mm area of mitral vegetation, which was believed to be related to the current vegetation. As anticoagulation produced no improvement, the mitral valve was replaced with a mechanical valve. Examination of the excised vegetation found it to be consistent with LS. The patient made good progress within 3 years after surgery. CONCLUSIONS LS size can increase despite anticoagulation in cases with high titers of all 3 antiphospholipid antibodies and cerebral infarction. Such patients require ongoing TEE follow-up and surgical treatment should be considered.

Recurrent Cerebral Infarction due to Cerebral Vasculitis in a Patient with Ulcerative Colitis

Vascular complications are extraintestinal manifestations of ulcerative colitis. Although there has been some controversy regarding the association between ulcerative colitis and stroke, hypercoagulability and systemic inflammation are thought to be possible factors contributing to stroke pathogenesis. Herein, we report a case of recurrent ischemic stroke with significant arterial stenosis. Cerebral vasculitis was suggested in high-resolution magnetic resonance vessel wall imaging (VWI) and marked improvement was confirmed by follow-up VWI after steroid treatment. This case suggests that VWI can be a useful tool to diagnose cerebral vasculitis and evaluate therapeutic effect.

Cerebral Infarction Caused by Trousseau's Syndrome Associated With Lung Cancer.

Lung cancer is one of the common cancers that can cause Trousseau's syndrome. However, there are few reports of cerebral infarction due to Trousseau's syndrome associated with lung cancer. The aim of this study is to investigate the clinical features of lung cancer-related cerebral infarction and effective management practice. Japanese patients diagnosed with Trousseau's syndrome-related cerebral infarction associated with lung cancer between August 2012 and November 2021 in our hospital were retrospectively enrolled. Clinical data, treatment, and outcomes of the patients were collected. Ten patients were enrolled. The median age was 65 years (range: 43 - 84 years). All patients had advanced lung cancer. The histological types were adenocarcinoma (n = 8), pleomorphic carcinoma (n = 1), and small cell lung cancer (n = 1). Recurrent cerebral infarction occurred in six patients. Among four patients who had continued heparin since the initial infarction, recurrence occurred in one. D-dimer was high in all 10 patients at the initial cerebral infarction. D-dimer level at the time of recurrent cerebral infarctions was higher than that at the first cerebral infarctions. Since performance status declined in nine patients, one patient continued anticancer drugs after cerebral infarction. Four patients died within 100 days of the onset of cerebral infarction. Cerebral infarction of lung cancer-related Trousseau's syndrome has poor prognosis. Heparin may be effective in controlling the condition. In addition, D-dimer may serve as a marker of cancer-related thrombosis.

Serum 4-hydroxynonenal associates with the recurrence of patients with primary cerebral infarction.

4-Hydroxynonenal (4-HNE), an α, β-unsaturated hydroxyalkenal, has been found to be associated with aspirin resistance, which is a risk factor for recurrent cerebral infarction. However, its effect on recurrent cerebral infarction is less defined. We designed this study to investigate the association between 4-HNE and increased risk of recurrent cerebral infarction. We recruited 189 patients with primary cerebral infarction from 2017 to 2019. According to the recurrence of cerebral infarction during the 3-year follow-up period, they were divided into two groups, namely, the non-recurrence group (n = 93) and the recurrence group (n = 96). All patients were analyzed to explore the risk factors for the recurrence of primary cerebral infarction and the predictive value of serum 4-HNE for the recurrence of cerebral infarction. The levels of serum 4-HNE in patients of the recurrence group were significantly higher than that in patients of the non-recurrence group. There was a positive correlation between serum 4-HNE levels and the serum levels of triglyceride (r = 0.448, p = 0.008) and low-density lipoprotein cholesterol (LDL-C; r = 0.442, p = 0.002) in primary cerebral infarction patients. Cox proportional hazards modeling showed that demographic and certain clinical parameters, such as age, serum triglyceride levels, the National Institutes of Health Stroke Scale (NIHSS) scores, and serum 4-HNE levels, were independent factors for the recurrence in patients. The results of the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) value of serum 4-HNE in patients with cerebral infarction recurrence was 0.703, and when the cutoff value of serum 4-HNE was set at 42.34 ng/ml, the sensitivity and specificity values of serum 4-HNE in predicting recurrent cerebral infarction were 79.20 and 52.70%, respectively. Serum 4-HNE is an independent risk factor for the recurrence of patients with primary cerebral infarction, and it may become a new intervention way to prevent the recurrence of patients with cerebral infarction.

A Case Report of the Hemostatic Effect of Samchilgeun Powder (Panax Motoginseng) on Hematuria in a Patient Requiring Double Antiplatelet Therapy Due to Recurrent Cerebral Infarction

Objective: The purpose of this study was to investigate the effect of Samchilgeun powder (panax notoginseng) on the treatment of hematuria in a patient requiring double antiplatelet therapy due to recurrent cerebral infarction.Methods: The patient was treated with Samchilgeun powder (panax notoginseng) combined with Western medicine (an antiplatelet). Urinalysis was performed to observe hematuria and proteinuria levels, and blood tests were used to evaluate anemia levels.Results: After treatment, hematuria levels decreased without exacerbation of anemia and proteinuria and even recurrence of cerebral infarction.Conclusions: This study suggests that Samchilgeun powder (panax notoginseng) can effectively treat patients with hematuria requiring double antiplatelet therapy due to recurrent cerebral infarction, but further studies should be conducted.

右側頭葉の脳梗塞の再発により社会的行動障害が出現した両側側頭葉損傷の 1 例

右側頭葉の脳梗塞の再発により社会的行動障害が出現した両側側頭葉損傷の 1 例

Effect of Standardized Perioperative Management on EEG Indexes and Nerve and Limb Functions of Patients with Acute Cerebral Infarction Undergoing Mechanical Thrombectomy.

Objective To explore the application value of standardized perioperative management in mechanical thrombectomy for acute cerebral infarction. Methods 98 patients with acute cerebral infarction admitted to our hospital from January 2019 to January 2022 were selected as the study sample in this study, and all patients were given the standardized perioperative management. According to the interventional methods, they were divided into the thrombolytic treatment group (arteriovenous combined thrombolysis, n = 49) and mechanical thrombectomy group (mechanical thrombectomy, n = 49) to compare the nerve function, limb function, thrombolysis in myocardial infarction (TIMI) flow grade, symptomatic intracranial hemorrhage within 24 hours, acute vascular reocclusion, and the death status within 1 year and incidence of adverse events in 90 days of the two groups after treatment. Results After treatment, the values of brain symmetry index (BSI) and power ratio indices (DTABR) in the two groups were obviously lower than those before treatment (P < 0.05), and the values of BSI and DTABR in the mechanical thrombectomy group were lower than those in the thrombolytic treatment group (P < 0.05). According to the statistical data of National Institutes of Health Stroke Scale (NIHSS) score in patients, the NIHSS scores of the two groups after treatment were visibly decreased (P < 0.05), while the NIHSS score in the mechanical thrombectomy group after treatment was lower than that in the thrombolytic treatment group (P < 0.05). The proportion of modified Rankin scale (mRS) score < 3 in the mechanical thrombectomy group was distinctly higher than that in the thrombolytic treatment group (P < 0.05). The proportion of TIMI flow grade ≥ 2 in the mechanical thrombectomy group was significantly higher than that in the thrombolytic treatment group (P < 0.05). The rate of symptomatic intracranial hemorrhage within 24 hours in the mechanical thrombectomy group was lower than that in the thrombolytic treatment group (P < 0.05), with the indistinctive difference between the two groups (P > 0.05). The incidence of acute vascular reocclusion in the mechanical thrombectomy group was markedly lower than that in the thrombolytic treatment group (P < 0.05). There was no significant difference in 1-year mortality between the two groups (P > 0.05). In the mechanical thrombectomy group, there were 1 case of gingiva bleeding, 1 case of hemorrhinia, and 2 cases of recurrent cerebral infarction in 90 days, with a total of 4 cases (8.16%), while in the thrombolytic treatment group, there were 4 cases of gingiva bleeding, 4 cases of hemorrhinia, and 15 cases of recurrent cerebral infarction in 90 days, with a total of 23 cases (46.94%), indicating that the incidence of adverse events in 90 days in the mechanical thrombectomy group was significantly lower than that in the thrombolytic treatment group (P < 0.05). Conclusion The standardized perioperative management is effective in patients with acute cerebral infarction who were treated with arteriovenous combined thrombolysis or mechanical thrombectomy, which can improve the neurological function and physical function of patients. However, the mechanical thrombectomy has a better improvement effect on the neurological function and physical function of patients, with the relatively better safety, thrombolytic effect, and long-term prognosis.

Patent Foramen Ovale and Risk of Recurrence in Stroke of Determined Etiology

Patent foramen ovale (PFO) is often found in stroke patients with determined etiologies. PFO may be the actual cause of stroke in some of them. We determined whether the risk of recurrent ischemic stroke differs with PFO status in stroke patients with determined etiologies. This study included consecutive patients with stroke of determined etiology who underwent transesophageal echocardiography. We compared the rates of recurrent cerebral infarction in patients with versus without PFO, and according to PFO-Associated Stroke Causal Likelihood (PASCAL) classification. Of 2,314 included patients, 827 (35.7%) had PFO. During a median follow-up of 4.4 years, cerebral infarction recurred in 202 (8.7%). In multivariate modified Cox regression analyses, recurrence of infarction did not significantly differ between patients with PFO and those without PFO (hazard ratio [HR]= 0.86, 95% confidence interval [CI]= 0.64-1.17, p= 0.339). Interaction analysis showed a significant effect of PFO in patients aged <65 years (adjusted p for interaction=0.090). PFO was independently associated with a decreased risk of recurrent infarction in patients younger than 65 years (HR=0.41, 95% CI=0.20-0.85, adjusted p= 0.016). Patients with probable PFO-associated stroke on the PASCAL classification had a significantly lower risk of recurrent infarction than those without PFO (HR=0.31, 95% CI=0.10-0.97, p= 0.044). Considering the generally low risk of recurrence in PFO-associated stroke, PFO may be the actual cause of stroke in some patients with determined etiologies, especially younger patients or those with PFO features of probable PFO-associated stroke. ANN NEUROL 2022;92:596-606.

Cerebral Infarction with Diffuse and Severe Atherosclerosis of The Main Cerebral Artery and Recurrent Infarction Despite Multiple Antiplatelet Agents: Treatment Strategy for Patients with Recurrent Cerebral Infarction During Antiplatelet Therapy

In real-world settings, many patients experience single or multiple recurrences of non-cardiogenic cerebral infarction, which is mainly caused by arteriosclerosis. These patients are treated according to set guidelines. While antiplatelet therapy is the standard treatment for preventing recurrence, this therapy alone is insufficient for full prevention of recurrence. Combining the administration of antiplatelet agents with the management of risk factors for recurrent cerebral infarction can maximize the preventive effects of these drugs.

Recurrent Cerebral Infarction Associated with Uterine Adenomyosis

Uterine adenomyosis, which is known as a benign gynecological disease, can induce hypercoagulable state and be an uncommon cause of cerebral thromboembolism, as cerebral infarction is common in patients with malignant neoplasm. We report a woman with uterine adenomyosis who shows several episodes of cerebral infarction and discuss the stoke mechanism and treatment of this under-recognized etiology of stroke.