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Multiple acute stroke syndrome: marker of embolic disease?
A E Baird1, K O Lövblad, G Schlaug
1Department of Neurology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA 02215, USA. abaird@caregroup.harvard.edu
Objective:
To determine the frequency and etiologic significance of multiple acute ischemic lesions in stroke.
Background:
Although patients may have more than one stroke during the course of their lives, acute ischemic stroke is usually thought of as a single event. Using diffusion-weighted imaging (DWI), an MRI technique that detects ischemic injury within minutes after onset, we have often observed multiple acute ischemic lesions.
Methods:
The MRI scans of 59 consecutively studied patients were reviewed to determine the frequency and etiologic significance of multiple acute ischemic lesions on DWI.
Results:
Multiple acute ischemic lesions were present in 10 (17%) of 59 patients. The lesions usually occurred within one major circulation (anterior or posterior), but in two patients (3%), lesions occurred in both cerebral hemispheres or in the anterior and the posterior circulations. The lesions often were small and resulted from presumed multiple emboli or the break-up of an embolus. Two patients had internal carotid artery occlusive disease and four had a cardiac or aortic source. In the other four patients the source was not determined. Lesions larger than 1 cm in diameter progressed to infarction, but some smaller lesions were not seen on follow-up T2-weighted imaging.
Conclusions:
Multiple acute stroke lesions on DWI are common and could be caused by multiple emboli or the breakup of an embolus. In some cases it might become possible to make early inferences concerning the stroke mechanism that could be of use for immediately directing the clinical work-up and treatment of the patient.
Insights
Multiple acute ischemic stroke lesions, detected by diffusion-weighted imaging (DWI), are common. These findings suggest embolic causes and may help direct early stroke work-up and treatment.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Acute ischemic stroke is typically viewed as a singular event.
- Diffusion-weighted imaging (DWI) detects acute ischemic injury within minutes of onset.
- Multiple acute ischemic lesions are frequently observed using DWI.
Purpose of the Study:
- To determine the frequency of multiple acute ischemic lesions in stroke patients.
- To investigate the etiologic significance of these multiple lesions.
- To assess the potential for early stroke mechanism inference.
Main Methods:
- Review of MRI scans from 59 consecutively studied stroke patients.
- Utilized diffusion-weighted imaging (DWI) to identify acute ischemic lesions.
- Analysis focused on lesion frequency, location, and size.
Main Results:
- Multiple acute ischemic lesions were found in 17% of patients.
- Lesions often occurred within a single major circulation (anterior/posterior).
- Presumed causes include multiple emboli or embolus fragmentation, with identified sources in carotid artery disease and cardiac/aortic conditions.
Conclusions:
- Multiple acute stroke lesions on DWI are common.
- These lesions may result from multiple emboli or embolus breakup.
- Early identification of stroke mechanisms can guide clinical work-up and treatment.