INTRODUCTION: Cardiac right-to-left shunt (RLS), mainly due to patent foramen ovale (PFO), is a risk factor for paradoxical embolism and stroke. Results of studies about brain lesions in diffusion-weighted imaging (DWI) in PFO patients were controversial. DWI only detects acute ischemic lesions. We assessed the hypothesis that, in T2-weighted magnetic resonance imaging (T2WI) of stroke patients, RLS is associated with a typical distribution of small white matter lesions. MATERIALS AND METHODS: In this retrospective case-control study, T2WI images of 162 stroke patients were evaluated. From stroke patients admitted between 1999 and 2003, 81 stroke patients with RLS were identified with contrast-enhanced transcranial Doppler (bubble test). Controls were 81 age-matched stroke patients without RLS (negative bubble test). In T2WI images, small lesions (<2 cm) were categorized depending on their location in subcortical white matter, peritrigonal white matter, deep and paraventricular white matter, and basal ganglia. Additionally, larger territorial infarcts were rated. RESULTS: In T2WI frontal or predominantly frontal-located subcortical small white matter, lesions are significantly associated with RLS (p < 0.0001, chi-square test). Forty-three patients with RLS (53%) and only 19 control patients (23%) showed this frontal dominance. Odds ratio is 3.7 (95% confidence interval = 1.9-7.1) for having a RLS when T2WI shows this lesion pattern in a stroke patient. No patient of the RLS group and 6% of the control group had parietal dominance. Distribution of small lesions in other locations like basal ganglia or deep white matter showed no significant difference for the groups. CONCLUSION: A distribution of mainly frontal subcortical small white matter lesions in T2WI is significantly associated with RLS in stroke patients.
INTRODUCTION: Cardiac right-to-left shunt (RLS), mainly due to patent foramen ovale (PFO), is a risk factor for paradoxical embolism and stroke. Results of studies about brain lesions in diffusion-weighted imaging (DWI) in PFO patients were controversial. DWI only detects acute ischemic lesions. We assessed the hypothesis that, in T2-weighted magnetic resonance imaging (T2WI) of strokepatients, RLS is associated with a typical distribution of small white matter lesions. MATERIALS AND METHODS: In this retrospective case-control study, T2WI images of 162 strokepatients were evaluated. From strokepatients admitted between 1999 and 2003, 81 strokepatients with RLS were identified with contrast-enhanced transcranial Doppler (bubble test). Controls were 81 age-matched strokepatients without RLS (negative bubble test). In T2WI images, small lesions (<2 cm) were categorized depending on their location in subcortical white matter, peritrigonal white matter, deep and paraventricular white matter, and basal ganglia. Additionally, larger territorial infarcts were rated. RESULTS: In T2WI frontal or predominantly frontal-located subcortical small white matter, lesions are significantly associated with RLS (p < 0.0001, chi-square test). Forty-three patients with RLS (53%) and only 19 control patients (23%) showed this frontal dominance. Odds ratio is 3.7 (95% confidence interval = 1.9-7.1) for having a RLS when T2WI shows this lesion pattern in a strokepatient. No patient of the RLS group and 6% of the control group had parietal dominance. Distribution of small lesions in other locations like basal ganglia or deep white matter showed no significant difference for the groups. CONCLUSION: A distribution of mainly frontal subcortical small white matter lesions in T2WI is significantly associated with RLS in strokepatients.
Authors: Leo H Bonati; Arnheid Kessel-Schaefer; André Z Linka; Peter Buser; Stephan G Wetzel; Ernst-Wilhelm Radue; Philippe A Lyrer; Stefan T Engelter Journal: Stroke Date: 2006-06-29 Impact factor: 7.914
Authors: F E de Leeuw; J C de Groot; E Achten; M Oudkerk; L M Ramos; R Heijboer; A Hofman; J Jolles; J van Gijn; M M Breteler Journal: J Neurol Neurosurg Psychiatry Date: 2001-01 Impact factor: 10.154
Authors: Sarah E Vermeer; Niels D Prins; Tom den Heijer; Albert Hofman; Peter J Koudstaal; Monique M B Breteler Journal: N Engl J Med Date: 2003-03-27 Impact factor: 91.245
Authors: David E Thaler; Robin Ruthazer; Emanuele Di Angelantonio; Marco R Di Tullio; Jennifer S Donovan; Mitchell S V Elkind; John Griffith; Shunichi Homma; Cheryl Jaigobin; Jean-Louis Mas; Heinrich P Mattle; Patrik Michel; Marie-Luise Mono; Krassen Nedeltchev; Federica Papetti; Joaquín Serena; Christian Weimar; David M Kent Journal: Stroke Date: 2013-01-22 Impact factor: 7.914