Related Experiment Videos
Are multiple acute small subcortical infarctions caused by embolic mechanisms?
D Chowdhury1, J M Wardlaw, M S Dennis
1Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. jmw@skull.dcn.ed.ac.uk
Journal of Neurology, Neurosurgery, and Psychiatry
|September 21, 2004
Summary
Most patients with multiple small subcortical infarcts on diffusion-weighted imaging (DWI) lacked embolic sources. Findings suggest a diffuse small vessel disease process, not embolism, underlies these stroke occurrences.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Multiple small subcortical infarcts on diffusion-weighted imaging (DWI) prompt investigation into stroke mechanisms.
- Identifying embolic sources is crucial for stroke management and prevention.
Purpose of the Study:
- To investigate potential embolic sources or alternative stroke mechanisms in patients with multiple recent subcortical infarcts on DWI.
- To characterize the underlying pathophysiology of these infarcts.
Main Methods:
- Prospective identification of stroke patients with multiple hyperintense subcortical infarcts on DWI.
- Independent and blinded clinical and radiological assessments.
Main Results:
- Only one of 10 patients had a definite embolic source.
- Most patients presented with hypertension and smoking history.
- DWI suggested infarcts occurred over weeks, not simultaneously.
- Common findings included white matter hyperintensities and microhemorrhages.
Conclusions:
- Embolic sources were uncommon; systemic vascular risk factors and small vessel disease features were prevalent.
- A generalized intrinsic process affecting small cerebral vessels may explain multiple acute subcortical infarcts.
- Further research is needed to explore the shared pathophysiological mechanisms of white matter hyperintensities, microhemorrhages, and multiple infarcts, potentially indicating diffuse cerebral microvascular abnormalities.