title: Multiple Infarcts Are Associated With Long-Term Stroke Recurrence and All-Cause Mortality in Cryptogenic Stroke Patients.
abstract: Brain infarct patterns that are observed via diffusion-weighted imaging are useful for classifying stroke subtypes. However, it is unclear whether infarct patterns can predict long-term outcomes in cryptogenic stroke patients. Herein, we investigated the association between acute brain infarct patterns and long-term stroke outcomes in cryptogenic stroke patients.
  
  
  
  Acute cryptogenic stroke patients were consecutively enrolled between April 2008 and March 2012. Diffusion-weighted imaging ischemic lesion patterns were classified as single lesions, scattered lesions in one vascular territory, or multiple lesions in multiple vascular territories. Survivors (at discharge) were followed up for 3 years after stroke onset.
  
  
  
  A total of 272 cryptogenic stroke patients (132 women; aged 72±13 years) were enrolled. Among these patients, 169 (62.1%) had a single lesion, 38 (14.0%) had scattered lesions, and 65 (23.9%) had multiple lesions. Next, 261 patients (96.0%) were evaluated to assess right-to-left shunting, and 61 patients (23.4%) exhibited right-to-left shunting. On patient admission, right-to-left shunting and increased D-dimer levels were independently associated with multiple lesions but not single or scattered lesions. During the follow-up period (median, 1093 days), 30 patients (11.0%) developed recurrent stroke and 35 patients (12.9%) died. Multivariate Cox proportional hazard analyses showed that multiple infarcts were independently associated with recurrent stroke and all-cause mortality (hazard ratio, 3.79; 95% confidence interval, 2.24-6.37; P<0.001).
  
  
  
  Multiple brain infarcts on diffusion-weighted imaging were independently associated with long-term stroke outcomes in cryptogenic stroke patients.
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.). dr.tom.n@gmail.com.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nezu
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mukai
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Takaya
authors.initials: T
authors.lastname: Kitano
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Yuko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: From the Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (T.N., T.M., J.U., M.Y., T.K., Y.W., Y.Y.); and Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (T.N.).
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yagita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D020520:Brain Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D015996:Survival Rate
keywords: atherosclerosis; plaques; prognosis; recurrence; stroke