title: Research article: clinical characteristics of isolated anterior cerebral artery territory infarction due to arterial dissection.
abstract: BACKGROUND
  Isolated brain infarction in the anterior cerebral artery (ACA) territory is rare, and its etiology has not yet been fully elucidated. Thus, we aimed to determine the etiologic and clinical characteristics of patients with isolated ACA territory infarction due to arterial dissection.
  
  
  METHODS
  Of 2315 patients with acute cerebral infarction admitted to our hospital between April 2007 and September 2013, 34 patients (1.5%; 28 men, 6 women; mean age, 65 ± 15 years) suffered isolated ACA territory infarction. We performed cranial magnetic resonance (MR) imaging and MR angiography for all the patients. Whenever possible, we also performed 3-dimensional computed tomography angiography, digital subtraction angiography, and MR cisternography to diagnose the stroke subtype.
  
  
  RESULTS
  The stroke subtypes of the 34 patients with isolated ACA territory infarction were atherothrombotic infarction, cardioembolic infarction, arterial dissection, and unclassified in 11 patients (32%), 11 patients (32%), 11 patients (32%), and 1 patient (3%), respectively. The mean ages at onset were 48 ± 9 and 72 ± 11 years in the dissection and nondissection groups, respectively (P < .001). Headaches were present at onset in 4 patients (36%) and 1 patient (4%) with and without dissection, respectively (P = .026). Blood pressure at onset was significantly higher among patients with dissection (systolic, 179 ± 34 mm Hg; diastolic, 102 ± 17 mm Hg) than among patients without dissection (systolic, 155 ± 30 mm Hg; diastolic, 86 ± 21 mm Hg; P < .05), and d-dimer values were significantly lower among patients with dissection (P = .034). Favorable clinical outcome (modified Rankin Scale score, 0-2) at discharge was achieved in 9 patients (82%) and 10 patients (43%) with and without dissection, respectively (P = .035).
  
  
  CONCLUSIONS
  Patients with isolated ACA territory infarction demonstrated a relatively high frequency of dissection (32%). Patients with dissection were younger, had a higher frequency of headaches, and demonstrated more favorable prognoses than patients without dissection.
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan. Electronic address: yuiton@saitama-med.ac.jp.
authors.forename: Yuito
authors.initials: Y
authors.lastname: Nagamine
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Deguchi
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Horiuchi
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Tanahashi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Cerebral infarction; anterior cerebral artery; dissection; magnetic resonance cisternography