[Identification of potential embolic source and consideration for ischemic lesion formation using the consecutive...

We investigated the 992 consecutive patients with acute embolic stroke and identified potential embolic sources (PES) for 88.3% applying transesophageal echocardiography (TEE). We classified patients into 3 groups, the Group A (n ‍= ‍560): PES were identified after general examinations, the Group B (n ‍= ‍366): PES were identified after TEE or long-term EEG monitoring and the Group C (n ‍= ‍66): TEE could not be performed. In Group A, continuous atrial fibrillation (cAf) was most prevalent (n ‍= ‍464, 82.8%), succeeded by myocardial infarction (n ‍= ‍39, 6.9%) and Trousseau syndrome (n ‍= ‍27, 4.8%), etc. In Group B, paroxysmal atrial fibrillation (pAf) was most prevalent (n ‍= ‍168, 45.9%), succeeded by paradoxical embolism (n ‍= ‍77, 21.0%) and aorto-embolism (n ‍= ‍77, 19.3%). We investigated the association of topographic diffusion-weighted imaging patterns (DWI) with PES. DWI was determined based on the arterial supply. Middle cerebral arteries were particularly divided into 4 segments, i.e., M1~M4. Moreover, M2 segments were subdivided into superior and inferior branches. The infarcts of larger caliber arteries such as internal carotid artery, M1 and M2, and multiple cortical branches were mostly associated with atrial fibrillation including cAf and pAf. Striatocapsular infarction were significantly associated with paradoxical embolism. Multiple small scattered infarcts were predominant in aorto-embolism as well as paradoxical embolism, Trousseau syndrome and thrombocytosis. The associations of DWI with different PES have their distinctive characteristics and may help predict PES in patients with embolic stroke of undetermined source. DWI pattern may be determined by the composition of thrombi and hydrodynamics of cerebral vasculature.