BACKGROUND: Detection of multiple acute brain infarcts (MABI) by diffusion weighted magnetic resonance imaging (DWI) may provide information about stroke mechanism in (1) acute lacunar stroke, where evidence of MABI suggests a cause other than small artery disease (SAD), such as embolism or vasculitis (type 1 MABI); or (2) acute non-lacunar stroke, where MABI in the territory of at least two of the aortic branches supplying the brain indicates the presence of aortic or cardiac embolism rather than artery to artery embolism (type 2 MABI). OBJECTIVE: To evaluate the prevalence of MABI and their impact on aetiological classification and prevention of stroke in patients with acute ischaemic stroke examined with DWI. METHODS: 182 consecutive patients defined by DWI were evaluated. Stroke aetiology was classified according to the TOAST criteria, though "lacunar stroke" included patients with possible aetiologies other than SAD. RESULTS: Type 1 MABI were detected in 21/72 patients (29%) with lacunar stroke, and type 2 MABI in 8/110 (7%) with non-lacunar stroke. A possible stroke mechanism different from SAD was found in nine type 1 MABI cases (43%): cardiac embolism (4); other determined aetiology (3); aortic embolism (2). Cardiac (2) or aortic (1) sources of embolism were detected in eight type 2 MABI cases. MABI patients with cardiac or aortic sources of embolism were treated with warfarin, the remainder with aspirin. CONCLUSIONS: Detection of type 1 MABI in patients with lacunar stroke improved diagnostic confidence and the choice of antithrombotic treatment. Further study is needed on stroke prevention in MABI cases caused by SAD alone.
BACKGROUND: Detection of multiple acute brain infarcts (MABI) by diffusion weighted magnetic resonance imaging (DWI) may provide information about stroke mechanism in (1) acute lacunar stroke, where evidence of MABI suggests a cause other than small artery disease (SAD), such as embolism or vasculitis (type 1 MABI); or (2) acute non-lacunar stroke, where MABI in the territory of at least two of the aortic branches supplying the brain indicates the presence of aortic or cardiac embolism rather than artery to artery embolism (type 2 MABI). OBJECTIVE: To evaluate the prevalence of MABI and their impact on aetiological classification and prevention of stroke in patients with acute ischaemic stroke examined with DWI. METHODS: 182 consecutive patients defined by DWI were evaluated. Stroke aetiology was classified according to the TOAST criteria, though "lacunar stroke" included patients with possible aetiologies other than SAD. RESULTS: Type 1 MABI were detected in 21/72 patients (29%) with lacunar stroke, and type 2 MABI in 8/110 (7%) with non-lacunar stroke. A possible stroke mechanism different from SAD was found in nine type 1 MABI cases (43%): cardiac embolism (4); other determined aetiology (3); aortic embolism (2). Cardiac (2) or aortic (1) sources of embolism were detected in eight type 2 MABI cases. MABI patients with cardiac or aortic sources of embolism were treated with warfarin, the remainder with aspirin. CONCLUSIONS: Detection of type 1 MABI in patients with lacunar stroke improved diagnostic confidence and the choice of antithrombotic treatment. Further study is needed on stroke prevention in MABI cases caused by SAD alone.
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Authors: J C Benson; S Payabvash; S Mortazavi; L Zhang; P Salazar; B Hoffman; M Oswood; A M McKinney Journal: AJNR Am J Neuroradiol Date: 2016-08-18 Impact factor: 3.825
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Authors: Anna K Bonkhoff; Teresa Ullberg; Martin Bretzner; Sungmin Hong; Markus D Schirmer; Robert W Regenhardt; Kathleen L Donahue; Marco J Nardin; Adrian V Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa C McIntosh; John Attia; John W Cole; Amanda Donatti; Christoph J Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven J Kittner; Robin Lemmens; Christopher R Levi; Caitrin W McDonough; James F Meschia; Chia-Ling Phuah; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Daniel Woo; Ramin Zand; Patrick F McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Ona Wu; Petrea Frid; Natalia S Rost; Johan Wasselius Journal: Front Neurosci Date: 2022-08-25 Impact factor: 5.152
Authors: Ahmed A Khalil; Marc Hohenhaus; Claudia Kunze; Wolf Schmidt; Peter Brunecker; Kersten Villringer; Klaus-Dietmar Merboldt; Jens Frahm; Jochen B Fiebach Journal: PLoS One Date: 2016-08-16 Impact factor: 3.240