title: Acute multiple brain infarction in large-artery atherosclerosis is associated with hyperhomocyst(e)inemia.
abstract: OBJECTIVE
  Although hyperhomocyst(e)inemia had been proven to be a potent risk factor for ischemic stroke, it is still controversial which subtype of stroke is associated with hyperhomocyst(e)inemia. The aim of this study was to clarify the association between plasma homocyst(e)ine (Hcy) levels and stroke subtypes according to TOAST classifications based on MRI findings.
  
  
  METHODS
  We prospectively recruited 124 consecutive first-ever ischemic stroke patients hospitalized in Toride Kyodo General Hospital. Each patient underwent brain MRI including diffusion-weighted imaging (DWI) and was evaluated for total plasma Hcy levels in addition to routine laboratory tests.
  
  
  RESULTS
  Of the 93 patients enrolled in this study, 19 were subtyped with large-artery atherosclerosis with acute multiple brain infarction [LA-AMBI(+)], 13 with LA-AMBI(-). Patients with LA-AMBI(+) showed significantly higher plasma Hcy levels than those with LA-AMBI(-). Moreover, for LA-AMBI, the plasma Hcy level was associated with an OR of 1.3 (95% CI 1.06-1.71, P=0.017) per 1 mumol increase in concentration, and 1.4 (95% CI 1.04-1.77, P=0.025) after adjustment for age, sex and serum cholesterol levels.
  
  
  CONCLUSIONS
  In the subset of patients with LA strokes, those with high Hcy levels are more likely to have AMBI than those without elevated Hcy levels possibly due to plaque instability.
authors.affiliation: Department of Neurology, Toride Kyodo General Hospital, Toride, Ibaraki, Japan. yokote@ncnp.go.jp
authors.forename: H
authors.initials: H
authors.lastname: Yokote
authors.forename: A
authors.initials: A
authors.lastname: Shiraishi
authors.forename: S
authors.initials: S
authors.lastname: Shintani
authors.forename: T
authors.initials: T
authors.lastname: Shiigai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000097:blood* / Q000150:complications / Q000473:pathology*; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000097:blood / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000209:etiology* / Q000473:pathology*