Brain infarction severity differs according to cardiac or arterial embolic source

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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
10:25

Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping

Published on: September 25, 2019

S G Timsit1, R L Sacco, J P Mohr

  • 1Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032.

Neurology
|April 1, 1993
PubMed

Insights

Cardiac embolism (EMB) and arterial embolic (tandem arterial pathology [TAP]) strokes present differently. EMB is linked to cardiac disease and decreased consciousness, while TAP is associated with transient ischemic attacks and superficial infarcts on CT scans.

Area of Science:

  • Neurology
  • Cardiology
  • Radiology

Background:

  • Cerebral infarction can stem from cardiac embolism (EMB) or tandem arterial pathology (TAP).
  • Distinguishing between these causes is crucial for effective stroke management and prevention.

Purpose of the Study:

  • To compare clinical and radiologic features of EMB and TAP in patients with cerebral infarction.
  • To identify differentiating factors for diagnosing the source of embolic stroke.

Main Methods:

  • Retrospective analysis of 246 EMB and 66 TAP patients from the Stroke Data Bank (1,273 total cerebral infarction patients).
  • Comparison of clinical data, including cardiac disease history, transient ischemic attacks, and carotid artery bruit.
  • Utilized multiple logistic regression analysis incorporating CT findings and hematocrit levels.

Main Results:

  • Cardiac disease was more frequent in EMB (78.4%) than TAP (29.3%).
  • Transient ischemic attacks (32.3% vs. 13.1%) and carotid artery bruit (15.1% vs. 3.3%) were more common in TAP.
  • Superficial infarct on CT (OR=4.6) and higher hematocrit increased TAP probability.
  • Decreased consciousness (OR=39.2) and abnormal initial CT (OR=3.2) increased EMB probability.

Conclusions:

  • EMB and TAP exhibit distinct clinical and radiologic profiles.
  • EMB is associated with cardiac sources and altered consciousness, often resulting in smaller, more distal cortical infarcts.
  • TAP is linked to arterial sources, transient ischemic attacks, and superficial infarcts, suggesting a different embolic particle size and distribution.

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