Are multiple acute small subcortical infarctions caused by embolic mechanisms?
OBJECTIVE
To seek evidence of potential embolic sources or other stroke mechanisms in patients who, on chance observation, had several apparently recent small subcortical infarcts on diffusion weighted magnetic resonance imaging (DWI).


METHODS
Patients presenting with stroke and multiple hyperintense subcortical infarcts visible on DWI were identified prospectively. Detailed clinical and radiological assessments were done independently and blinded to each other.


RESULTS
Of 10 patients with multiple hyperintense subcortical infarcts on DWI, a definite embolic source was identified in only one. Most patients were hypertensive and smoked. The DWI appearance suggested that the subcortical lesions had occurred within several weeks rather than at exactly the same time. Most patients also had significant white matter hyperintensities and four had microhaemorrhages.


CONCLUSIONS
Embolic sources were not identified in most patients but they did have systemic vascular risk factors and brain imaging features of "small vessel disease." A more generalised intrinsic process affecting many small cerebral vessels contemporaneously could explain multiple acute small subcortical infarcts. White matter hyperintensities, microhaemorrhages, and multiple small subcortical infarcts may share a common pathophysiological mechanism such as a diffuse cerebral microvascular abnormality which requires further exploration.
Chowdhury
D
D
Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. jmw@skull.dcn.ed.ac.uk
Wardlaw
J M
JM
Dennis
M S
MS
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000209:etiology* / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D020766:Intracranial Embolism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects