Acute ischemic stroke patterns in infective and nonbacterial thrombotic endocarditis: a diffusion-weighted magnetic resonance imaging study.
OBJECTIVE
Although infective endocarditis (IE) and nonbacterial thrombotic endocarditis (NBTE) are associated with cardioembolic stroke, differences in the nature of these conditions may result in differences in associated stroke patterns. We compared patterns of acute and recurrent ischemic stroke in IE and NBTE, using diffusion-weighted MRI (DWI).


METHODS
Using ICD-9 diagnostic codes and medical record review, we identified 362 patients (387 episodes) with IE and 14 patients with NBTE. Thirty-five patients (with 27 episodes of IE, 9 NBTE) who underwent 36 initial and 29 follow-up DWI scans were selected for this study. DWI lesion size, number, and location were compared between groups and correlated with stroke syndromes and endocarditis features.


RESULTS
DWI was abnormal in all but 2 patients. Four acute stroke patterns were identified: (1) single lesion, (2) territorial infarction, (3) disseminated punctate lesions, and (4) numerous small (<10 mm) and medium (10 to 30 mm) or large (>30 mm) lesions in multiple territories. All patients with NBTE exhibited pattern 4, whereas those with IE exhibited patterns 1, 2, 3, and 4 (6, 2, 8 and 9 episodes, respectively). Seventy-five percent of patients with pattern 3 exhibited the clinical syndrome of embolic encephalopathy. Vegetation size, valve, and organisms had no correlation with stroke patterns.


CONCLUSIONS
DWI has utility in differentiating between IE and NBTE. Patients with NBTE uniformly have multiple, widely distributed, small and large strokes, whereas patients with IE exhibit a panoply of stroke patterns.
Singhal
Aneesh B
AB
Stroke Service, Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass 02114, USA. asinghal@partners.org
Topcuoglu
Mehmet A
MA
Buonanno
Ferdinando S
FS
D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications*; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000145:classification / Q000150:complications / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis*