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Ii Y, Ishikawa H, Nishigaki A, Utsunomiya T, Nakamura N, Hirata Y, Matsuyama H, Kajikawa H, Matsuura K, Matsuda K, Shinohara M, Kishi S, Kogue R, Umino M, Maeda M, Tomimoto H, Shindo A. Superficial small cerebellar infarcts in cerebral amyloid angiopathy on 3 T MRI: A preliminary study. J Neurol Sci 2024; 459:122975. [PMID: 38527411 DOI: 10.1016/j.jns.2024.122975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Strictly superficial cerebellar microbleeds and cerebellar superficial siderosis have been considered markers of advanced cerebral amyloid angiopathy (CAA), but there are few studies on cerebellar ischemic lesions in CAA. We investigated the presence of superficial small cerebellar infarct (SCI) ≤15 mm and its relation to magnetic resonance imaging (MRI) markers in patients with probable CAA. METHODS Eighty patients with probable CAA were retrospectively evaluated. The presence of superficial SCIs was examined, along with cerebellar microbleeds and cerebellar superficial siderosis, using 3-T MRI. Lobar cerebral microbleeds, cortical superficial siderosis (cSS), enlargement of the perivascular space in the centrum semiovale, and white matter hyperintensity were assessed and the total CAA-small vessel disease (SVD) score was calculated. RESULTS Nine of the 80 patients (11.3%) had a total of 16 superficial SCIs. By tentatively defining SCI <4 mm as cerebellar microinfarcts, 8 out of 16 (50%) superficial SCIs corresponded to cerebellar microinfarcts. The total CAA-SVD score was significantly higher in patients with superficial SCIs (p = 0.01). The prevalence of cSS (p = 0.018), cortical cerebral microinfarct (p = 0.034), and superficial cerebellar microbleeds (p = 0.006) was significantly higher in patients with superficial SCIs. The number of superficial cerebellar microbleeds was also significantly higher in patients with superficial SCIs (p = 0.001). CONCLUSIONS Our results suggest that in patients with CAA, superficial SCIs (including microinfarcts) on MRI may indicate more severe, advanced-stage CAA. These preliminary findings should be verified by larger prospective studies in the future.
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Affiliation(s)
- Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; Department of Neuroimaging and Pathophysiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akisato Nishigaki
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takaya Utsunomiya
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Naoko Nakamura
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hiroyuki Kajikawa
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kana Matsuda
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaki Shinohara
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Seiya Kishi
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Ryota Kogue
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Dekeyzer S, Vanden Bossche S, De Cocker L. Anything but Little: a Pictorial Review on Anatomy and Pathology of the Cerebellum. Clin Neuroradiol 2023; 33:907-929. [PMID: 37410171 DOI: 10.1007/s00062-023-01326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
Despite its small size the cerebellum is an anatomically complex and functionally important part of the brain. Traditionally the cerebellum is viewed as a motor control structure entirely devoted to motor control and learning, but recent functional magnetic resonance imaging (fMRI) studies demonstrated significant involvement of the cerebellum in higher order cognitive functions. The anatomical complexity of the cerebellum is reflected by the several nomenclature systems that exist for the description of cerebellar anatomy. The cerebellum can be affected by a variety of pathological processes, including congenital, infectious and inflammatory, neoplastic, vascular, degenerative and toxic metabolic diseases. The purpose of this pictorial review is to (1) provide a general overview of cerebellar anatomy and function, (2) demonstrate normal cerebellar anatomy on imaging studies, and (3) illustrate both common as well as rare pathological conditions affecting the cerebellum.
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Affiliation(s)
- Sven Dekeyzer
- Department of Radiology and Medical Imaging, Ghent University Hospital (UZG), Corneel Heymanslaan 10, 9000, Gent, Belgium.
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
- Department of Radiology, AZ Sint Jan Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Laurens De Cocker
- Department of Radiology, AZ Maria Middelares Gent, Buitenring-Sint-Denijs 30, 9000, Gent, Belgium
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3
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Wang W, Ji J, Wang C, Wang Y. Topography and etiologies of cerebellar infarcts presenting as isolated acute vestibular syndrome. Neurol Sci 2022; 43:5969-5976. [DOI: 10.1007/s10072-022-06249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
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4
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Yu L, Li X, Hou Y, Hu H, Bai M, Yang L, Hu W. Incidence and clinical features of acute multiple small cerebellar infarction. J Stroke Cerebrovasc Dis 2022; 31:106777. [PMID: 36174324 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/18/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the clinical and imaging features and to identify possible etiology of acute multiple small cerebellar infarction (MSCI). METHODS We retrospectively enrolled 220 patients with acute cerebellar infarction, divided them into MSCI and large cerebellar infarction (LCI) groups, according to the quantity and size of lesions confirmed by MRI analysis. Clinical and imaging features were compared between the two groups to explore the possible etiology and pathogenesis. RESULTS Among 220 patients, 90 patients presented MSCI symptoms. The proportions of extracerebellar lesions (P = 0.001) and bilateral infarction (P = 0.001) in the MSCI group were higher than those in the LCI group. No significant differences were found in terms of age, gender, and common vascular risk factors between the two groups. The proportions of vertigo and headache in the MSCI group were significantly lower than those in the LCI group (P < 0.000 and 0.034, respectively), and limb weakness was significantly higher (P = 0.039) in the MSCI patients. Moreover, the proportions of nystagmus and ataxia in the MSCI group were significantly lower than those in the LCI group (P < 0.043 and 0.003, respectively). The MSCI group had higher proportions of ACA and MCA stenosis, while the proportion of posterior circulation stenosis was similar between the two groups. Infarctions involving the posterior inferior cerebellar (PICA) region and mixed territories were far more frequent than those involving the anterior inferior cerebellar artery (AICA) region and superior cerebellar artery (SCA) territory (P < 0.05). Large-artery atherosclerosis and multiple plus undetermined etiology were the main etiological factors of MSCI. CONCLUSION In patients with acute cerebellar infarction, 30% of patients presented with MSCI. MSCI and LCI showed similar vascular risk factors and vascular stenosis in the posterior circulation system. Patients with MSCI should pay more attention to evaluating anterior circulation vessels' anatomy. Large-artery atherosclerosis was the main pathogenesis of acute MSCI. Assessment of cerebral vessels might be critically required in patients with MSCI complicated atrial fibrillation.
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Affiliation(s)
- Ling Yu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, PR China
| | - Xuanting Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China
| | - Yutong Hou
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China
| | - Hongmei Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China
| | - Mingyue Bai
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China.
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, South Gongti Road, Beijing 100020, PR China
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5
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Chen CH, Lee M, Weng HH, Lee JD, Yang JT, Tsai YH, Huang YC. Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke. Front Neurol 2022; 13:952462. [PMID: 36176550 PMCID: PMC9513827 DOI: 10.3389/fneur.2022.952462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeThe early identification of cardioembolic stroke is critical for the early initiation of anticoagulant treatment. However, it can be challenging to identify the major cardiac source, particularly since the predominant source, paroxysmal atrial fibrillation (AF), may not be present at the time of stroke. In this study, we aimed to evaluate imaging predictors for unrecognized AF in patients with acute ischemic stroke.MethodsWe performed a cross-sectional analysis of data and magnetic resonance imaging (MRI) scans from two prospective cohorts of patients who underwent serial 12-lead electrocardiography and 24-h Holter monitoring to detect unrecognized AF. The imaging patterns in diffusion-weighted imaging and imaging characteristics were assessed and classified. A logistic regression model was used to identify predictive factors for newly detected AF in patients with acute ischemic stroke.ResultsA total of 734 patients were recruited for analysis, with a median age of 72 (interquartile range: 65–79) years and a median National Institutes of Health Stroke Scale score of 4 (interquartile range: 2–6). Of these patients, 64 (8.7%) had newly detected AF during the follow-up period. Stepwise multivariate logistic regression revealed that age ≥75 years [adjusted odds ratio (aOR) 5.66, 95% confidence interval (CI) 2.98–10.75], receiving recombinant tissue plasminogen activator treatment (aOR 4.36, 95% CI 1.65–11.54), congestive heart failure (aOR 6.73, 95% CI 1.85–24.48), early hemorrhage in MRI (aOR 3.62, 95% CI 1.52–8.61), single cortical infarct (aOR 6.49, 95% CI 2.35–17.92), and territorial infarcts (aOR 3.54, 95% CI 1.06–11.75) were associated with newly detected AF. The C-statistic of the prediction model for newly detected AF was 0.764.ConclusionInitial MRI at the time of stroke may be useful to predict which patients have cardioembolic stroke caused by unrecognized AF. Further studies are warranted to verify these findings and their application to high-risk patients.
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Affiliation(s)
- Chao-Hui Chen
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Hsu-Huei Weng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Jen-Tsung Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Yuan-Hsiung Tsai
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
| | - Yen-Chu Huang
- Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, Taiwan
- *Correspondence: Yen-Chu Huang
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6
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Pimentel BC, Ingwersen T, Haeusler KG, Schlemm E, Forkert ND, Rajashekar D, Mouches P, Königsberg A, Kirchhof P, Kunze C, Tütüncü S, Olma MC, Krämer M, Michalski D, Kraft A, Rizos T, Helberg T, Ehrlich S, Nabavi DG, Röther J, Laufs U, Veltkamp R, Heuschmann PU, Cheng B, Endres M, Thomalla G. Association of stroke lesion shape with newly detected atrial fibrillation – Results from the MonDAFIS study. Eur Stroke J 2022; 7:230-237. [PMID: 36082264 PMCID: PMC9446317 DOI: 10.1177/23969873221100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed
by the usual diagnostic workup after ischemic stroke. We aimed to determine
whether shape characteristics of ischemic stroke lesions can be used to predict
AF in stroke patients without known AF at baseline. Lesion shape quantification
on brain MRI was performed in selected patients from the intervention arm of the
Impact of standardized MONitoring for Detection of Atrial
Fibrillation in Ischemic Stroke (MonDAFIS) study, which included
patients with ischemic stroke or TIA without prior AF. Multiple morphologic
parameters were calculated based on lesion segmentation in acute brain MRI data.
Multivariate logistic models were used to test the association of lesion
morphology, clinical parameters, and AF. A stepwise elimination regression was
conducted to identify the most important variables. A total of 755 patients were
included. Patients with AF detected within 2 years after stroke
(n = 86) had a larger overall oriented bounding box (OBB)
volume (p = 0.003) and a higher number of brain lesion
components (p = 0.008) than patients without AF. In the
multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35,
p < 0.001), age (OR 2.13, 95%CI 1.52–3.06,
p < 0.001), and female sex (OR 2.45, 95%CI 1.41–4.31,
p = 0.002) were independently associated with detected AF.
Ischemic lesions in patients with detected AF after stroke presented with a more
dispersed infarct pattern and a higher number of lesion components. Together
with clinical characteristics, these lesion shape characteristics may help in
guiding prolonged cardiac monitoring after stroke.
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Affiliation(s)
- Bernardo Crespo Pimentel
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Thies Ingwersen
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Wurzburg, Germany
- German Atrial Fibrillation Network (AFNET), Münster, Germany
| | - Eckhard Schlemm
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Pauline Mouches
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Alina Königsberg
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- German Atrial Fibrillation Network (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, UK
- Departments of Cardiology, UHB and SWBH NHS Trusts, Birmingham, UK
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Serdar Tütüncü
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel C Olma
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Krämer
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Michalski
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andrea Kraft
- Department of Neurology, Martha Maria Hospital, Halle Dölau, Germany
| | - Timolaos Rizos
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Torsten Helberg
- Department of Neurology, Clinical Center of Hubertusburg, Wermsdorf, Germany
| | - Sven Ehrlich
- Clinical Center of Hubertusburg, Wermsdorf, Germany
| | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Ulrich Laufs
- Department of Cardiology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Brain Sciences, Imperial College London, UK
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center & Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Wurzburg, Germany
| | - Bastian Cheng
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Endres
- University Heart and Vascular Center Hamburg, Hamburg, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Partner Site Berlin, Germany
- German Center for Cardiovascular Diseases, Partner Site Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Götz Thomalla
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Vynckier J, Kaesmacher J, Wardlaw JM, Roten L, Beyeler M, Belachew NF, Grunder L, Seiffge DJ, Jung S, Gralla J, Dobrocky T, Heldner MR, Prange U, Goeldlin MB, Arnold M, Fischer U, Meinel TR. Phenotypes of Chronic Covert Brain Infarction in Patients With First-Ever Ischemic Stroke: A Cohort Study. Stroke 2021; 53:558-568. [PMID: 34525841 PMCID: PMC8785517 DOI: 10.1161/strokeaha.121.034347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: The aim of this study was to assess the rate of chronic covert brain infarctions (CBIs) in patients with acute ischemic stroke (AIS) and to describe their phenotypes and diagnostic value. Methods: This is a single-center cohort study including 1546 consecutive patients with first-ever AIS on magnetic resonance imaging imaging from January 2015 to December 2017. The main study outcomes were CBI phenotypes, their relative frequencies, location, and association with vascular risk factors. Results: Any CBI was present in 574/1546 (37% [95% CI, 35%–40%]) of patients with a total of 950 CBI lesions. The most frequent locations of CBI were cerebellar in 295/950 (31%), subcortical supratentorial in 292/950 (31%), and cortical in 213/950 (24%). CBI phenotypes included lacunes (49%), combined gray and white matter lesions (30%), gray matter lesions (13%), and large subcortical infarcts (7%). Vascular risk profile and white matter hyperintensities severity (19% if no white matter hyperintensity, 63% in severe white matter hyperintensity, P<0.001) were associated with presence of any CBI. Atrial fibrillation was associated with cortical lesions (adjusted odds ratio, 2.032 [95% CI, 1.041–3.967]). Median National Institutes of Health Stroke Scale scores on admission were higher in patients with an embolic CBI phenotype (median National Institutes of Health Stroke Scale, 5 [2–10], P=0.025). Conclusions: CBIs were present in more than a third of patients with first AIS. Their location and phenotypes as determined by MRI were different from previous studies using computed tomography imaging. Among patients suffering from AIS, those with additional CBI represent a vascular high-risk subgroup and the association of different phenotypes of CBIs with differing risk factor profiles potentially points toward discriminative AIS etiologies.
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Affiliation(s)
- Jan Vynckier
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.).,Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.K., N.F.B., L.G., J.G., T.D.)
| | | | - Joanna Marguerite Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom. (J.W.).,UK Dementia Research Institute, University of Edinburgh, United Kingdom. (J.W.)
| | - Laurent Roten
- Department of Cardiology, University of Edinburgh, United Kingdom. (L.R.)
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Nebiyat Filate Belachew
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.K., N.F.B., L.G., J.G., T.D.)
| | - Lorenz Grunder
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.K., N.F.B., L.G., J.G., T.D.)
| | - David Julian Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.K., N.F.B., L.G., J.G., T.D.)
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.K., N.F.B., L.G., J.G., T.D.)
| | - Mirjam Rachel Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Ulrike Prange
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Martina Béatrice Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland. (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.)
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8
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Trandafir C, Sandiramourty S, Laurent-Chabalier S, Ter Schiphorst A, Nguyen H, Wacongne A, Ricci JE, Pereira F, Thouvenot E, Renard D. Brain Infarction MRI Pattern in Stroke Patients with Intracardiac Thrombus. Cerebrovasc Dis 2021; 50:581-587. [PMID: 34139688 DOI: 10.1159/000515707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute infarction patterns have been described in cardioembolic stroke, mainly with atrial fibrillation (AF) or patent foramen ovale. We aimed to analyse acute infarction magnetic resonance imaging (MRI) characteristics in stroke patients with intracardiac thrombus (ICT) compared with stroke patients with AF. METHODS We performed a retrospective study analysing brain MRI scans of consecutive acute symptomatic cardioembolic infarction patients associated with ICT or AF who were recruited and registered in the stroke database between June 2018 and November 2019. Diffusion-weighted imaging performed within 1 week after symptom onset, intra-/extracranial vessel imaging, echocardiography, and ≥24-h ECG monitoring were required for inclusion. Baseline, biological, and echocardiography characteristics were assessed. Analysed MRI characteristics were infarction location (anterior/middle/posterior cerebral artery territory; anterior/posterior/mixed anterior-posterior circulation; multiterritorial infarction; brainstem; cerebellum; small cortical cerebellar infarctions [SCCIs] or non-SCCI; cortical/subcortical/cortico-subcortical), lesion number, subcortical lesion size (> or <15 mm), and total infarction volume. RESULTS We included 28 ICT and 94 AF patients presenting with acute stroke. ICT patients were younger (median age 66 vs. 81 years, p < 0.001), more frequently male (79 vs. 47%, p = 0.003), and smokers (39 vs. 17%, p = 0.013), had more frequent history of diabetes (36 vs. 18%, p = 0.049) and ischaemic heart disease (57 vs. 21%, p < 0.001), and had lower HDL cholesterol levels (0.39 vs. 0.53 g/L, p < 0.001). On MRI, SCCI was more frequent in the ICT group (25 vs. 5%, p = 0.006) in the absence of other differences in infarction localisation, number, size, or volume on MRI. On multivariate analysis, younger age (p < 0.001), history of ischaemic heart disease (p < 0.001), and low HDL cholesterol levels (p = 0.01) were significantly associated with ICT. Results approaching statistical significance were observed for SCCI (more frequent in the ICT group, p = 0.053) and non-SCCI (more frequent in the AF group, p = 0.053) on MRI. CONCLUSIONS ICT-related stroke is associated with acute SCCI presence on MRI. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04456309.
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Affiliation(s)
- Cassiana Trandafir
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Shridevi Sandiramourty
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University of Montpellier, Nîmes, France
| | | | - Hai Nguyen
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Anne Wacongne
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Jean-Etienne Ricci
- Department of Cardiology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Fabricio Pereira
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, CNRS UMR5203, INSERM 1191, University of Montpellier, Montpellier, France
| | - Dimitri Renard
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
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Sharobeam A, Churilov L, Parsons M, Donnan GA, Davis SM, Yan B. Patterns of Infarction on MRI in Patients With Acute Ischemic Stroke and Cardio-Embolism: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:606521. [PMID: 33363511 PMCID: PMC7753023 DOI: 10.3389/fneur.2020.606521] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Cardioembolic strokes are common however atrial fibrillation, the most common cause, is often asymptomatic and difficult to detect. There is evidence that infarct topography and volume on magnetic resonance imaging may be associated with specific stroke etiologies. Aim: A systematic review and meta-analysis were undertaken to summarize the available evidence on the association between stroke etiology, infarct topography, and volume. Methods: A systematic review was conducted using Medline (OVID), Embase (OVID), and PubMed databases. Hand searches of the gray literature and of reference lists in relevant articles were also performed. A quality assessment was undertaken, based on the STROBE checklist. For each study, the number of patients with and without a CE source of stroke and infarct topography was collected and outcomes presented as odds ratios (OR) with 95% CI and p-values. Results: Four thousand eight hundred and seventy-three patients with ischemic stroke were included, of whom 1,559 were determined to have a CE source. Bilateral infarcts (OR 3.41; 95% CI 2.20–5.29; p < 0.0001) and multiple territory infarcts (OR 1.57; 95% CI 1.12–2.21; p = 0.009) were more common in patients with a CE source of stroke, than patients without a CE source. Lacunar infarcts (OR 0.49; 95% CI 0.31–0.80; p = 0.004) were more likely to occur in patients without a CE source. No significant difference between the frequency of multiple infarcts (OR 0.96; 95% CI 0.57–1.61; p = 0.87) anterior circulation (OR 1.45; 95% CI 0.83–2.53; p = 0.19) or posterior circulation infarcts (OR 1.06; 95% CI 0.72–1.57; p = 0.75), between the two groups were identified. Three out of four studies examining volume, found a significant association between increased infarct volume and CE source of stroke. A sensitivity analysis with cryptogenic and undetermined stroke sources assumed to be cardioembolic, did not alter the associations observed. Conclusion: The findings of this systematic review and meta-analysis are broadly consistent with previous literature and provide more robust evidence on the association between infarct topography, volume and stroke etiology. Our findings may assist with refining cardiac investigations for patients with cryptogenic stroke, based on infarct topography.
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Affiliation(s)
- Angelos Sharobeam
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Leonid Churilov
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mark Parsons
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia.,South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW, Australia.,Department of Neurology, Liverpool Hospital, Liverpool, NSW, Australia.,The Ingham Institute, Liverpool, NSW, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen M Davis
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Bernard Yan
- Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology (L.R.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (T.R.M., U.F.), Inselspital, Bern University Hospital, University of Bern, Switzerland
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