title: Stroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native South Asian Pakistanis.
abstract: BACKGROUND
  There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native South Asian Pakistanis.
  
  
  METHODS
  Men and women aged ≥ 18 years with acute stroke presenting to four tertiary care hospitals in Karachi, Pakistan were screened using magnetic resonance angiography/transcranial Doppler scans. Trial of ORG 10172 in Acute Stroke Treatment criteria were applied to identify strokes from intracranial atherosclerotic disease.
  
  
  RESULTS
  We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89.0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42.2% (87/206) followed by border-zone infarcts (52/206, 25.2%). Increasing degrees of stenosis correlated with the development of both cortical and border-zone strokes (P = 0.002). Important associated findings were frequent atrophy (166/230, 72.2%), silent brain infarcts (66/230, 28%) and a marked lack of severe leukoaraiosis identified in only 68/230 (29.6%). A total of 1870 arteries were studied individually. Middle cerebral artery was the symptomatic stroke vessel in half, presenting with complete occlusion in 66%. Evidence of biological disease, symptomatic or asymptomatic was identified in 753 (40.2%) vessels of which 543 (72%) were significantly (>50%) stenosed at presentation.
  
  
  CONCLUSIONS
  Intracranial atherosclerotic disease is a diffuse process in Pakistani south Asians, with involvement of multiple vessels in addition to the symptomatic vessel. The middle cerebral artery is the most frequent symptomatic vessel presenting with cortical embolic infarcts. There is a relative lack of leukoaraiosis. Concomitant atrophy, silent brain infarcts and recent ischaemia in the symptomatic territory are all frequently associated findings.
authors.affiliation: Stroke Service and the International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Maria
authors.initials: M
authors.lastname: Khan
authors.forename: Asif
authors.initials: A
authors.lastname: Rasheed
authors.forename: Saman
authors.initials: S
authors.lastname: Hashmi
authors.forename: Moazzam
authors.initials: M
authors.lastname: Zaidi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Murtaza
authors.forename: Saba
authors.initials: S
authors.lastname: Akhtar
authors.forename: Lajpat
authors.initials: L
authors.lastname: Bansari
authors.forename: Nabi
authors.initials: N
authors.lastname: Shah
authors.forename: Maria
authors.initials: M
authors.lastname: Samuel
authors.forename: Sadaf
authors.initials: S
authors.lastname: Raza
authors.forename: Umer Rais
authors.initials: UR
authors.lastname: Khan
authors.forename: Bilal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Bilawal
authors.initials: B
authors.lastname: Ahmed
authors.forename: Naveeduddin
authors.initials: N
authors.lastname: Ahmed
authors.forename: Jamal
authors.initials: J
authors.lastname: Ara
authors.forename: Tasnim
authors.initials: T
authors.lastname: Ahsan
authors.forename: S M
authors.initials: SM
authors.lastname: Munir
authors.forename: Shoukat
authors.initials: S
authors.lastname: Ali
authors.forename: Khalid
authors.initials: K
authors.lastname: Mehmood
authors.forename: Karim Ullah
authors.initials: KU
authors.lastname: Makki
authors.forename: Muhammad Masroor
authors.initials: MM
authors.lastname: Ahmed
authors.forename: Niaz
authors.initials: N
authors.lastname: Sheikh
authors.forename: Abdul Rauf
authors.initials: AR
authors.lastname: Memon
authors.forename: Philippe M
authors.initials: PM
authors.lastname: Frossard
authors.forename: Ayeesha Kamran
authors.initials: AK
authors.lastname: Kamal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000208:ethnology / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000208:ethnology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000208:ethnology; D020521:Stroke / Q000208:ethnology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult