title: Cerebrovascular Dissemination in Time and Space as a Predictor of Cardioembolism.
abstract: BACKGROUND
  Cardioembolism has tendency to recur and cause lesions in distinct cerebrovascular territories. Using the imaging characteristics of cerebral lesions to determine dissemination in time and space (DTS) is a concept already used in other neurologic conditions; however, it has never been applied as a diagnostic tool in ischemic stroke etiology.
  
  
  OBJECTIVE
  This study aimed to assess DTS as a diagnostic marker of cardioembolism.
  
  
  METHODS
  We enrolled consecutive patients with acute ischemic stroke of various etiologies admitted in a cerebrovascular disease nursery from a university hospital in a retrospective cohort study. We excluded patients with coexisting etiologies, incomplete study, or without an acute vascular lesion on computed tomography scan. Lacunar infarctions were not considered. Cerebrovascular territory was divided into right anterior, left anterior, and posterior. Localization of the acute vascular lesion(s), existence of previous vascular lesions, and their respective areas were analyzed. The presence of dissemination in time, space, or DTS was determined.
  
  
  RESULTS
  We included 661 patients (mean age: 74.05 years (SD: 13.01)). Cardioembolism was the etiology with most DTS (30.47% of cardioembolic strokes); DT occurred more frequently within the atherosclerotic subtype (9.88%); DS was more prevalent within the arterial dissection group (3.33%). There was a statistically significant difference in stroke etiology between patients with DTS and patients without dissemination (P < .001). DTS had 81.67% specificity, 30.47% sensitivity, 66.67% positive predictive value, and 49.40% negative predictive value for the identification of cardioembolism.
  
  
  CONCLUSIONS
  DTS is a specific diagnostic predictor of cardioembolic stroke and may be helpful in guiding etiologic investigation.
authors.affiliation: Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
authors.forename: João André
authors.initials: JA
authors.lastname: Sousa
authors.affiliation: Neuroradiology Department, Serviço de Imagem Médica do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Mafalda
authors.initials: M
authors.lastname: Mendes-Pinto
authors.affiliation: Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Electronic address: jsargentof@hotmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Sargento-Freitas
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Silva
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Cecília
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Carmo
authors.initials: C
authors.lastname: Macário
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Gouveia
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Machado
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rodrigues
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Gustavo C
authors.initials: GC
authors.lastname: Santo
authors.affiliation: Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Lima
authors.affiliation: Neuroradiology Department, Serviço de Imagem Médica do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Veiga
authors.affiliation: Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Cunha
authors.affiliation: Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Freire-Gonçalves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006785:Hospitals, University; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: CT scan; Ischemic stroke; atrial fibrillation; cardiac emboli; diagnostic method; stroke subtypes