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Brain infarction severity differs according to cardiac or arterial embolic source
S G Timsit1, R L Sacco, J P Mohr
1Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032.
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.
Abstract:
We compared clinical and radiologic features between 246 cardiac embolism (EMB) and 66 arterial embolic (tandem arterial pathology [TAP]) patients selected from the 1,273 patients with cerebral infarction in the Stroke Data Bank. Diagnostic definitions accounted for the increased frequency of cardiac disease among patients with EMB compared with TAP (78.4% versus 29.3%), while transient ischemic attacks (32.3% versus 13.1%) and carotid artery bruit (15.1% versus 3.3%) were more prevalent in TAP than in EMB. Multiple logistic regression differentiated TAP and EMB further. The probability of a TAP diagnosis was increased by the CT finding of a superficial infarct alone (odds ratio [OR] = 4.6; 95% CI = 1.5 to 13.7) or by a higher admission hematocrit. The probability of EMB was greater in patients with an initial decreased consciousness (OR = 39.2; 95% CI = 4.0 to 381.3) or with an abnormal first CT (OR = 3.2; 95% CI = 1.2 to 8.6). These findings indicate that the two infarct subtypes differ in the location and extent of the cortical infarction, which argues for a smaller particle size, with smaller and more distal infarction in embolism from an arterial source compared with cardiogenic embolism.