title: Multidetector computed tomography angiography to detect the cause of multiple brain infarctions.
abstract: BACKGROUND
  Multidetector computed tomography angiography (MDCTA) is useful to inspect cardiovascular pathologic changes with minimal invasiveness. Here we evaluated the usefulness of MDCTA to determine the cause of acute multiple brain infarction (AMBI).
  
  
  METHODS
  AMBI was defined as multiple recent infarcts demonstrated on diffusion-weighted imaging. A new infarction within 2 weeks from the last was also considered an AMBI.
  
  
  RESULTS
  Between January 2012 and December 2013, 967 patients were diagnosed with acute brain infarction and 138 (14.3%) with AMBI. Among them, 57 (39 men and 18 women; age, 38-93 years) were examined by MDCTA using the dual-phase method. All images were diagnostic, even if patients found it difficult to hold their breath. Fifteen patients (26.3%) were diagnosed with patent foramen ovale (PFO). Two had complications of atrial fibrillation (AF), necessitating anticoagulant therapy (ACT). Four had both PFO and severe aortic atherosclerotic plaque formation, necessitating single antiplatelet therapy (APT) and/or ACT. Fifteen patients (26.3%) developed complicated arterial plaques around the aortic arch and were administered single or dual APT and/or ACT, except 1 patient with a history of multiple cerebral bleeding. Nine patients had pre-existing AF. Furthermore, ACT was initiated for 2 other patients with thrombus or circulatory stasis in the left atrial appendage despite normal electrocardiographic findings. Two other patients were diagnosed with advanced cancer, which was considered Trousseau syndrome. The cause of AMBI was determined in 36 (63.2%) patients.
  
  
  CONCLUSIONS
  MDCTA is a useful and less invasive method to identify the cause of embolic infarction.
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama. Electronic address: kawada@kyokuto.or.jp.
authors.forename: Sanami
authors.initials: S
authors.lastname: Kawada
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Hamaguchi
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama.
authors.forename: Michio
authors.initials: M
authors.lastname: Kitayama
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama.
authors.forename: Takaki
authors.initials: T
authors.lastname: Imamura
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ohno
authors.affiliation: Department of Neurology, Okayama Kyokuto Hospital, Okayama.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kashihara
authors.affiliation: Department of Cardiovascular Medicine, Okayama Kyokuto Hospital, Okayama.
authors.forename: Kouichiro
authors.initials: K
authors.lastname: Iwasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012008:Recurrence; D012307:Risk Factors
keywords: Multidetector computed tomography angiography; acute multiple brain infarctions; complicated aortic plaque; left atrial appendage thrombus; patent foramen ovale