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Atrial fibrillation with small subcortical infarcts
D K Jung1, G Devuyst, P Maeder
1Department of Neurology, Centre Hospitalier Universitaire Vaudois, CH-1011, Lausanne, Switzerland. Denise.Allasia@chuv.hospvd.ch
Journal of Neurology, Neurosurgery, and Psychiatry
|February 22, 2001
Summary
This study found that both small artery disease and cardioembolism can cause small subcortical infarcts in patients with atrial fibrillation. Differentiating between these causes may be possible using specific clinical and radiological findings.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Small subcortical infarcts (SSI) are common, but their etiology in patients with atrial fibrillation (AF) remains debated.
- Distinguishing between small artery disease (SAD) and cardioembolism as the cause of SSI is crucial for appropriate management.
Purpose of the Study:
- To characterize small subcortical infarcts (SSI) in patients with atrial fibrillation (AF).
- To compare SSI characteristics between patients with and without AF, and to explore potential etiological factors.
Main Methods:
- Retrospective analysis of 27 patients with chronic AF and isolated SSI (SSI-AF group).
- Comparison with 45 age-matched controls with SSI but no identified embolic source (SSI-control group).
- Subgroup analysis of SSI-AF patients based on the presence (SSI-AF-SAD+) or absence (SSI-AF-SAD-) of hypertension or diabetes mellitus.
Main Results:
- While hypertension and diabetes were equally distributed, suggesting SAD is a common cause, AF patients showed more neuropsychological disturbances (15% vs 2%).
- Factors more frequent in SSI-AF-SAD- patients included secondary hemorrhagic transformation, pure motor weakness, subinsular infarcts, and better neurological recovery.
- These findings suggest cardioembolism as a potential cause in some AF patients with SSI.
Conclusions:
- Both small artery disease (SAD) and cardioembolism can cause SSI in patients with atrial fibrillation (AF).
- AF may not be coincidental in patients with SSI and lacunar stroke.
- Specific clinical and radiological findings can aid in differentiating cardioembolic SSI from SAD-related SSI.