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The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by
K Takahashi1, S Kobayashi, R Matui
1Third Department of Internal Medicine, Shimane Medical University, Izumo, Shimane, Japan. kazuo-ta@shimane-med.ac.jp
Objectives:
The cause of small infarction is mainly considered to be intracranial small-vessel disease. However, it is difficult to explain the mechanism of multiple, acute infarctions by small-vessel disease. We examined the differences of clinical parameters between patients with multiple small lesions and single lesion detected by Diffusion-weighted MRI (DWI).
Material And Methods:
We reviewed the clinical records of 86 consecutive stroke patients with lacunar size ischemic lesions on DWI during the acute stage (within 72 h of onset). The subjects were 55 males and 31 females (mean age 72.4 +/- 9.9 years). Small multiple acute ischemic lesions were defined using the following criteria 1): the lesions were detectable by DWI 2), the diameter of each lesion on DWI was less than 1.5 cm, and 3) more than one vascular territory was involved. Included in the analysis were age, sex, lipoprotein (a) levels, hematocrit, atrial fibrillation (Af), stenosis of middle cerebral artery (MCA), internal carotid artery (ICA) or basilar artery stenosis detected by magnetic resonance angiography (MRA), National Institute of Health Stroke Scale (NIHSS) at admission, and a history of hypertension, diabetes mellitus, hyperlipidemia, and smoking.
Results:
Twenty-one (24.4%) out of 86 patients with small acute infarctions had multiple acute ischemic lesions. Multiple logistic regression analysis showed that Af and stenosis of ICA or basilar artery were significantly more prevalent in patients with multiple lesions than single lesions.
Conclusion:
Multiple, small lesions visible in DWI are likely to be caused by emboli from heart or atheroma of the large vessels than single small lesion.
Insights
Multiple small strokes detected by Diffusion-weighted MRI (DWI) are linked to heart emboli or large vessel disease, not just small-vessel disease. Atrial fibrillation and artery stenosis are key indicators in stroke patients with multiple lesions.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Intracranial small-vessel disease is the primary suspected cause of small infarcts.
- The mechanism of multiple, acute infarctions is difficult to explain solely by small-vessel disease.
- Diffusion-weighted MRI (DWI) detects acute ischemic lesions.
Purpose of the Study:
- To investigate the clinical differences between patients with multiple small ischemic lesions and those with single lesions.
- To identify potential causes of multiple small acute infarctions beyond small-vessel disease.
Main Methods:
- Retrospective review of 86 acute stroke patients (within 72h of onset) with lacunar-sized ischemic lesions on DWI.
- Analysis of clinical parameters including age, sex, lipoprotein (a), hematocrit, atrial fibrillation (Af), artery stenosis (MCA, ICA, basilar), NIHSS, and medical history.
- Definition of multiple lesions: detectable by DWI, <1.5 cm diameter, involving >1 vascular territory.
Main Results:
- 24.4% of patients (21/86) presented with multiple acute ischemic lesions.
- Atrial fibrillation (Af) and internal carotid artery (ICA) or basilar artery stenosis were significantly more prevalent in patients with multiple lesions.
- Multiple logistic regression identified Af and ICA/basilar artery stenosis as key factors associated with multiple lesions.
Conclusions:
- Multiple small lesions on DWI suggest embolic sources from the heart or large vessel atheroma.
- Findings challenge the sole attribution of small infarcts to intracranial small-vessel disease.
- Identifying these risk factors aids in understanding and potentially preventing multiple acute ischemic events.