Spotty cortical enhancement detected by magnetic resonance imaging: a sign of embolic transient ischemic attack and stroke?
OBJECTIVE
Patients with transient ischemic attack (TIA) or minor stroke occasionally have spotty cortical lesions that are visualized with contrast-enhanced magnetic resonance imaging studies. We attempted to clarify the clinical characteristics of patients with these findings by giving them the name spotty cortical enhancement (SCE).


METHODS
Out of 746 consecutive patients with acute ischemic stroke or TIA, 29 patients had the SCE in the region of the middle cerebral artery. We defined the SCE as a cortical lesion less than 1.5 cm in diameter, as visualized by contrast-enhanced magnetic resonance imaging within 30 days of symptom onset. Neurologic symptoms and signs, potential cardiac sources of emboli, or arterial disease were evaluated in all patients with SCE.


RESULTS
The patients always had an abrupt onset of symptoms. Cortical signs without hemiparesis were observed in 4 patients, cortical signs with hemiparesis in 6, monoparesis in 11, and mild to moderate hemiparesis alone in the remaining 8 patients. The deficits were fully recovered within the first 24 hours in 13 patients and within 30 days in the other patients. Significant cerebral arterial lesions (> or =50% stenosis in diameter) and potential cardiac sources of emboli were found in 21 and 7 patients, respectively. In only 3 patients (10.3%), neither cardiac sources nor arterial stenosis could be detected.


CONCLUSIONS
The present results suggest that the SCE indicates small cortical infarcts caused by cardiogenic or artery-to-artery embolism. Patients with the SCE should be distinguished clinically from those with lacunar stroke or with hemodynamic TIA or stroke.
Wada
K
K
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Kimura
K
K
Minematsu
K
K
Uchino
M
M
Yamaguchi
T
T