Time patterns in multiple acute cerebral infarcts.
Background Multiple acute cerebral infarcts in different arterial territories may be caused by several emboli concurrently or successively. Aim and/or hypothesis We hypothesized that the time from stroke onset to magnetic resonance imaging may shed light on underlying mechanisms of multiple acute cerebral infarcts. Methods This is a prospective observational cohort study involving 2697 ischemic stroke patients conducted at Haukeland University Hospital between February 2006 and October 2013. Only patients with diffusion-weighted imaging lesions in more than one arterial territory (left or right anterior circulation or posterior circulation) were included. The time from stroke onset to magnetic resonance imaging was registered and correlated with the etiology of multiple acute cerebral infarcts in each patient. Results We reviewed 2697 consecutive patients and 2220 (82%) underwent magnetic resonance imaging. Among these 2125 (96%) had diffusion-weighted imaging lesions. We found 187 multiple acute cerebral infarct patients who were then included in the study. There was positive correlation (0.20; p < .001) between time to magnetic resonance imaging and frequency of multiple acute cerebral infarcts caused by internal carotid stenosis. There was no correlation (-.02) between time to magnetic resonance imaging and frequency of multiple acute cerebral infarcts caused by cardiogenic embolism. Conclusions Multiple acute cerebral infarcts associated with cardiogenic embolism seem to happen concurrently as a shower of emboli whereas multiple acute cerebral infarcts associated with internal carotid artery stenosis seem to occur successively separated by hours or days.
1 Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Vojtech
V
Novotny
1 Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|3 Nasjonalforeningen for folkehelsen, Oslo, Norway.
Andrej N
AN
Khanevski
1 Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|2 Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Lars
L
Thomassen
1 Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|4 Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
Ulrike
U
Waje-Andreassen
1 Centre for Neurovascular Diseases, Department of Neurology, Haukeland University Hospital, Bergen, Norway.|2 Department of Clinical Medicine, University of Bergen, Bergen, Norway.|5 Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.
Halvor
H
Naess
D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D016014:Linear Models; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors
Multiple infarcts; cardioembolism; carotid stenosis; diffusion-weighted magnetic resonance imaging; ischemic stroke; magnetic resonance imaging; time patterns