title: Significance of acute multiple infarcts in multiple cerebral circulations on initial diffusion weighted imaging in stroke patients.
abstract: OBJECTIVE
  We attempted to assess the frequency, clinical and neuroradiological features of concomitant Acute Multiple Infarcts in Multiple Cerebral Circulations (AMIMCC) and to classify their causes.
  
  
  METHODS
  Consecutive patients treated for MR DWI-confirmed infarcts were included in this cohort. We retrospectively analyzed all patients with AMIMCC of our prospective database, studying clinical and radiological features. Causes of stroke were classified using TOAST and ASCO system (atherosclerosis, small vessel disease, cardiac source, other causes).
  
  
  RESULTS
  Eighty AMIMCC were identified out of 824 consecutive patients with MR DWI-confirmed infarcts (9.7%). Compared with single infarct patients, AMIMCC patients presented similar age and risk factors. Only 24 AMIMCC patients (30%) presented symptoms suggesting multiple lesions before MRI. Cardiac origin existed in 39 of 80 patients (49%) including atrial fibrillation in 25 patients. Other sources of AMIMCC were hematologic diseases or coagulopathies such as intravascular coagulation in relation with cancer (n = 6; 7,5%) and vasculitis or systemic disorders (n = 5;6,5%). AMIMCC also appeared to originate from unilateral carotid diseases or intracranial stenosis, mostly atheromatous, in association with anatomic variations(n = 9;11%). In 21 patients, no cause was identified despite extensive investigations (26%). According to TOAST classification, 62% had a definite source for infarcts, 67% according to ASCO grade 1 classification. MRI data did not permit to orientate etiological explorations according to DWI appearance, associated leucoaraiosis or previous infarcts on FLAIR or microbleeding on gradient-echo sequences.
  
  
  CONCLUSIONS
  AMIMCC are not rare and mostly need MRI to be detected. Multiple and various etiologies are implicated, including cardioembolic diseases in half of them, but also hematologic disorders and angeitis.
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Department of Neurology Le Kremlin-Bicêtre, France.
authors: S
authors: S
authors: Depuydt
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Department of Neurology Le Kremlin-Bicêtre, France.
authors: M
authors: M
authors: Sarov
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Neuroradiology Le Kremlin-Bicêtre, France.
authors: C
authors: C
authors: Vandendries
authors: Department of Neurology Le Kremlin-Bicêtre, France.
authors: T
authors: T
authors: Guedj
authors: Department of Neurology Le Kremlin-Bicêtre, France.
authors: C
authors: C
authors: Cauquil
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Cardiology Le Kremlin-Bicêtre, France.
authors: P
authors: P
authors: Assayag
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Internal Medicine, Bicêtre Hospital Le Kremlin-Bicêtre, France.
authors: O
authors: O
authors: Lambotte
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Neuroradiology Le Kremlin-Bicêtre, France; INSERM U788, Le Kremlin-Bicêtre, France.
authors: D
authors: D
authors: Ducreux
authors: PARIS XI-Sud University Le Kremlin-Bicêtre, France; Department of Neurology Le Kremlin-Bicêtre, France; INSERM U788, Le Kremlin-Bicêtre, France. Electronic address: christian.denier@bct.aphp.fr.
authors: C
authors: C
authors: Denier
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology*; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology; D020520:Brain Infarction / Q000175:diagnosis* / Q000209:etiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*
keywords: Atrial fibrillation; Diffusion weighted imaging; Hematological; Multiple; Stroke; Vasculitis; Viscosity