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Naftali J, Barnea R, Eliahou R, Pardo K, Tolkovsky A, Adi M, Hasminski V, Saliba W, Bloch S, Raphaeli G, Leader A, Auriel E. Lung cancer is associated with acute ongoing cerebral ischemia: A population-based study. Int J Stroke 2024; 19:406-413. [PMID: 37978833 DOI: 10.1177/17474930231217670] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however, they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types. METHODS We used the Clalit Health Services record (representing more than 5 million patients) to identify adults with LC and breast, pancreatic, or colon cancer (non-lung cancer, NLC) who underwent brain magnetic resonance diffusion (MRI) scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed, and CMIs were documented, as well as cardiovascular risk factors. RESULTS Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI were found in 73/2056 (3.5%) MRI scans of LC group compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of NLC (p < 0.01). Cancer type (e.g. LC vs NLC) was the only associated factor with CMI incidence on multivariate analysis. After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients and 0.5 in NLC. DISCUSSION CMIs are common findings in cancer patients, especially in LC patients and therefore might serve as a marker for occult brain ischemia, cognitive decline, and cancer-related stroke (CRS) risk.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ruth Eliahou
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Tolkovsky
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Meital Adi
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Vadim Hasminski
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sivan Bloch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Guy Raphaeli
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Avi Leader
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Marcucci M, Chan MTV, Smith EE, Absalom AR, Devereaux PJ. Prevention of perioperative stroke in patients undergoing non-cardiac surgery. Lancet Neurol 2023; 22:946-958. [PMID: 37739575 DOI: 10.1016/s1474-4422(23)00209-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 09/24/2023]
Abstract
About 300 million adults undergo non-cardiac surgery annually. Although, in this setting, the incidence of perioperative stroke is low, the absolute number of patients experiencing a stroke is substantial. Furthermore, most patients with this complication will die or end up with severe disability. Covert brain infarctions are more frequent than overt strokes and are associated with postoperative delirium, cognitive decline, and cerebrovascular events at 1 year after surgery. Evidence shows that traditional stroke risk factors including older age, hypertension, and atrial fibrillation are also associated with perioperative stroke; previous stroke is the strongest risk factor for perioperative stroke. Increasing evidence also suggests the pathogenic role of perioperative events, such as hypotension, new atrial fibrillation, paradoxical embolism, and bleeding. Clinicians involved in perioperative care should be aware of this evidence on prevention strategies to improve patient outcomes after non-cardiac surgery.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Anthony R Absalom
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
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Naftali J, Barnea R, Eliahou R, Tolkovsky A, Pardo K, Zukerman M, Soback N, Adi M, Leader A, Bloch S, Saliba W, Auriel E. Cerebral Microinfarcts Are Common in Undiagnosed Lung Cancer Patients: A Population-Based Study. Acta Neurol Scand 2023. [DOI: 10.1155/2023/9240247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Background. Cerebral microinfarcts (CMI) represent covert brain ischemia and were associated with stroke risk and cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. The relationship between malignancy and CMI is unknown. Aims. We aimed to examine whether CMI is more common in patients with undiagnosed lung cancer, and therefore might serve as a prediction marker for cognitive impairment or cancer-related stroke. Methods. We used the computerized database of Clalit Health Services (the largest healthcare provider in Israel) to identify adults diagnosed with lung cancer who had an MRI brain scan for any indication prior to cancer diagnosis. We analyzed DWI sequences, in order to evaluate CMI incidence in this population, and compared it to control groups of patients with other undiagnosed malignancies and patients without known cancer. Results. Altogether, we reviewed 1822 MRI brain scans, of which 497 scans were taken in patients with undiagnosed lung cancer, 543 scans of noncancer patients, and 793 scans of patients with other undiagnosed malignancies. In the lung cancer group, we found 24 CMI, compared with 4 in the noncancer group (
) and 8 in the other cancer group (
). Conclusions. CMI is common in undiagnosed lung cancer patients compare to other undiagnosed cancer types or noncancer patients. At the time of lung cancer diagnosis patients may be at risk for future stroke or cognitive decline.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ruth Eliahou
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Tolkovsky
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Keshet Pardo
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
| | - Michal Zukerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noa Soback
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Meital Adi
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Kaplan Medical Center, Rehovot, Israel
| | - Avi Leader
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Sivan Bloch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neurology, Lady Davis Carmel Medical Center, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Israel
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Can novel CT-and MR-based neuroimaging biomarkers further improve the etiological diagnosis of lobar intra-cerebral hemorrhage? J Neurol 2023; 270:582-588. [PMID: 36307736 DOI: 10.1007/s00415-022-11434-y] [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: 06/27/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/07/2023]
Abstract
Lobar hematomas represent around half of all supratentorial hemorrhages and have high mortality and morbidity. Their management depends on the underlying cause. Apart from local causes such as vascular malformation, which are rare and can usually be easily excluded thanks to imaging, the vast majority of lobar hematomas equally frequently result from either hypertensive arteriolopathy (HA) or cerebral amyloid angiopathy (CAA). Distinguishing between CAA and HA is important for prognostication (risk of recurrence nearly sevenfold higher in the former), for decision-making regarding, e.g., antithrombotic therapies (for other indications) and for clinical trials of new therapies. Currently, a non-invasive diagnosis of probable CAA can be made using the MR-based modified Boston criteria, which have excellent specificity but moderate sensitivity against histopathological reference, leading to the clinically largely irrelevant diagnosis of "possible CAA". Furthermore, the Boston criteria cannot be applied when both lobar and deep MRI hemorrhagic markers are present, a not uncommon situation. Here we propose to test whether new CT and MR-based imaging biomarkers, namely finger-like projections of the hematoma and adjacent subarachnoid hemorrhage on acute-stage CT or MRI, and remote punctate diffusion-weighted imaging ischemic lesions on acute or subacute-stage MRI, have the potential to improve the performance of the Boston criteria. Furthermore, we also propose to test whether clinical-radiological biomarkers may also allow a positive diagnosis of HA to be made in lobar hematomas, which, if feasible, would not only further reduce the prevalence of "possible CAA" but also permit a diagnosis of HA and/or CAA to be made in the presence of mixed deep and lobar MRI hemorrhagic markers.
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van Lith TJ, Sluis WM, Wijers NT, Meijer FJA, Kamphuis-van Ulzen K, de Bresser J, Dankbaar JW, van den Heuvel FMA, Antoni ML, Mulders-Manders CM, de Mast Q, van de Veerdonk FL, Klok FA, Tuladhar AM, Cannegieter SC, Wermer MJH, van der Worp HB, Huisman MV, de Leeuw FE. Prevalence, risk factors, and long-term outcomes of cerebral ischemia in hospitalized COVID-19 patients – study rationale and protocol of the CORONIS study: A multicentre prospective cohort study. Eur Stroke J 2022; 7:180-187. [PMID: 35647315 PMCID: PMC9134783 DOI: 10.1177/23969873221092538] [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: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 12/18/2022] Open
Abstract
Background: COVID-19 is often complicated by thrombo-embolic events including ischemic
stroke. The underlying mechanisms of COVID-19-associated ischemic stroke,
the incidence and risk factors of silent cerebral ischemia, and the
long-term functional outcome in these patients are currently unknown. Patients and methods: CORONavirus and Ischemic Stroke (CORONIS) is a multicentre prospective cohort
study investigating the prevalence, risk factors and long-term incidence of
(silent) cerebral ischemia, and the long-term functional outcome among
patients with COVID-19. We aim to include 200 adult patients hospitalized
with COVID-19 without symptomatic ischemic stroke to investigate the
prevalence of silent cerebral ischemia compared with 60 (matched) controls
with MRI. In addition, we will identify potential risk factors and/or causes
of cerebral ischemia in COVID-19 patients with (n = 70) or
without symptomatic stroke (n = 200) by means of blood
sampling, cardiac workup and brain MRI. We will measure functional outcome
and cognitive function after 3 and 12 months with standardized
questionnaires in all patients with COVID-19. Finally, the long-term
incidence of (new) silent cerebral ischemia in patients with COVID-19 will
be assessed with follow up MRI (n = 120). Summary: The CORONIS study is designed to add further insight into the prevalence,
long-term incidence and risk factors of cerebral ischemia, and the long-term
functional outcome in hospitalized adult patients with COVID-19.
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Affiliation(s)
- Theresa J van Lith
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wouter M Sluis
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Naomi T Wijers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederick JA Meijer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | | | - M Louisa Antoni
- Department of Cardiology, Heart and Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Quirijn de Mast
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederikus A Klok
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne C Cannegieter
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Menno V Huisman
- Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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Ay H. Classification of Ischemic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ortiz M, Jahngir M, Qualls K, Litofsky NS, Nattanmai P, Qureshi A. In Reply to the Letter to the Editor Regarding "Intra-arterial Dantrolene for Refractory Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage". World Neurosurg 2020; 143:614. [PMID: 33167142 DOI: 10.1016/j.wneu.2020.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Ortiz
- Division of Neurosurgery, Department of Surgery, University of Missouri Hospital and Clinics, Columbia, Missouri, USA.
| | - Muhammad Jahngir
- Department of Neurology, Orange Park Medical Center, Orange Park, Florida, USA
| | - Kathryn Qualls
- Clinical Pharmacy, Neurosciences, University of Missouri Hospital and Clinics, Columbia, Missouri, USA
| | - N Scott Litofsky
- Division of Neurosurgery, Department of Surgery, University of Missouri Hospital and Clinics, Columbia, Missouri, USA
| | - Premkumar Nattanmai
- Department of Neurology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA
| | - Adnan Qureshi
- Department of Neurology, University of Missouri Hospital and Clinics, Columbia, Missouri, USA
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8
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Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology. J Neuroophthalmol 2020; 38:328-333. [PMID: 29369960 DOI: 10.1097/wno.0000000000000613] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology. DESIGN Retrospective, cross-sectional study. SUBJECTS Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included. METHODS A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital. Patients were included if vision loss was unilateral and due to transient monocular vision loss (TMVL), central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Any patients with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, nonvascular intraocular pathology, and intracranial pathology other than ischemic stroke. MAIN OUTCOME MEASURES The presence or absence of acute stroke on diffusion-weighted imaging (DWI) on brain MRI. RESULTS A total of 641 records were reviewed, with 293 patients found to have MVL. After excluding those with focal neurologic deficits, there were 41 patients who met the inclusion criteria and received a brain MRI. Eight of the 41 subjects (19.5%) were found to have findings on brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in TMVL subjects, 4/12 (33.3%) in CRAO subjects, and 2/5 (40%) in BRAO subjects. Brain computed tomography (CT) scans were not able to identify the majority of acute stroke lesions in this study. CONCLUSIONS Patients with MVL of vascular etiology such as TMVL, CRAO, or BRAO may have up to 19.5% risk of concurrent ischemic stroke, even when there are no other neurologic deficits. These strokes were detected acutely with brain MRI using DWI but were missed on CT.
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Hilal S, Baaij LG, de Groot M, Niessen WJ, Ikram MK, Ikram MA, Vernooij MW. Prevalence and clinical relevance of diffusion-weighted imaging lesions. Neurology 2019; 93:e1058-e1067. [DOI: 10.1212/wnl.0000000000008090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/14/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo examine the association of diffusion-weighted image (DWI) lesions with markers of cerebrovascular disease, neurodegeneration, and cognitive functioning and to further explore the evolution of these DWI lesions and their link to risk of dementia, stroke, or TIA in the Rotterdam Study.MethodsTwo thousand one hundred seventy-six participants with baseline MRI scans (assessed between January 2009 and December 2013) and data on incident clinical outcomes (until January 2016) were included. DWIs were inspected for presence of acute or subacute lesions. Markers of cerebrovascular disease, brain tissue segmentation, and microstructural integrity were collected. Cognition was assessed with a detailed neuropsychological test. Evolution of DWI lesions was evaluated on follow-up scans.ResultsThirty-three individuals (1.5%) had ≥1 DWI lesions. Persons with lacunes, white matter hyperintensities (WMHs), and reduced white matter microstructural integrity were more likely to have DWI lesions. Persons with DWI lesions performed worse on Stroop test 1. For 17 of 33 persons, follow-up scans were available to determine lesion evolution. During a mean follow-up of 4.7 years, 58.8% of DWI lesions appeared as WMHs, 17.6% developed cavitation, 5.9% changed into cortical cerebral microinfarcts, and 17.6% disappeared. People with DWI lesions at baseline were at increased risk of strokes (hazard ratio 3.72, 95% confidence interval 1.35–10.27).ConclusionAsymptomatic DWI lesions in community-dwelling persons are associated with markers of cerebral small vessel disease, reduced microstructural integrity, and worse cognition. Presence of DWI lesions increases the risk of further strokes. Future investigations will have to show whether screening and treating persons with DWI lesions can effectively reduce the burden of stroke.
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Le Moigne E, Timsit S, Ben Salem D, Didier R, Jobic Y, Paleiron N, Le Mao R, Joseph T, Hoffmann C, Dion A, Rousset J, Le Gal G, Lacut K, Leroyer C, Mottier D, Couturaud F. Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism: A Prospective Cohort Study. Ann Intern Med 2019; 170:756-763. [PMID: 31060047 DOI: 10.7326/m18-3485] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism. OBJECTIVE To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected. DESIGN Prospective cohort study with masked assessment of stroke outcomes. (ClinicalTrials.gov: NCT01216423). SETTING 4 French hospital centers. PARTICIPANTS 361 consecutive patients with symptomatic acute PE from 13 November 2009 through 21 December 2015. INTERVENTION Systematic contrast transthoracic echocardiography (TTE) and cerebral magnetic resonance imaging (MRI) within 7 days after enrollment. MEASUREMENTS Recent symptomatic or silent ischemic stroke was diagnosed on the basis of clinical examination and cerebral MRI showing a hypersignal on the trace diffusion-weighted image with reduction or pseudonormalization of apparent diffusion coefficient. RESULTS Contrast TTE was conclusive in 324 of 361 patients and showed PFO in 43 patients (13%). The median age was 66 years (interquartile range, 54 to 77 years). In total, 51% of patients (145/284) had associated deep venous thrombosis, 91% (279/306) had cardiovascular risk factors, and 10% (16/151) presented with arrhythmia (no difference between PFO and non-PFO groups). Cerebral MRI was conclusive in 315 patients. Recent ischemic stroke was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]). LIMITATION Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis. CONCLUSION Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important mechanism of ischemic stroke in patients with PFO. PRIMARY FUNDING SOURCE French Ministry of Health.
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Affiliation(s)
- Emmanuelle Le Moigne
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Serge Timsit
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Douraied Ben Salem
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Romain Didier
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Yannick Jobic
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | | | - Raphael Le Mao
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | | | - Clément Hoffmann
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Angelina Dion
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | | | - Grégoire Le Gal
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Karine Lacut
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Christophe Leroyer
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Dominique Mottier
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
| | - Francis Couturaud
- Brest University Hospital, Western Brittany University, Brest, France (E.L., S.T., D.B., R.D., Y.J., R.L., C.H., A.D., G.L., K.L., C.L., D.M., F.C.)
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Izutsu N, Fujimoto Y, Yamada N, Kajikawa R, Yoshimura K, Nagashima M, Wakayama A, Yoshimine T. Small Hyperintensities in the Area of the Perforating Arteries in Patients with Seizure. Eur Neurol 2018; 79:221-227. [DOI: 10.1159/000488673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/20/2018] [Indexed: 11/19/2022]
Abstract
Background/Aim: We previously observed spotty hyperintense lesions in the region of the perforating arteries on peri-ictal diffusion-weighted imaging (DWI); however, no report has formally described these findings. The aim of this study was to investigate focal intensities on peri-ictal DWI, and to evaluate the clinical significance of these lesions. Methods: We conducted a retrospective review of 677 consecutive patients with seizure who completed peri-ictal DWI within 24 h after seizure onset. Patients were grouped according to the presence or absence of diffusion hyperintense lesions (DHLs) in the region of the perforating arteries. We compared clinical and imaging characteristics between these 2 groups. Results: Among 677 patients, 23 patients (3.4%) had DHLs. Analyses of apparent diffusion coefficient values and fluid attenuated inversion recovery images suggested that DHLs were acute or subacute ischemic lesions that had appeared prior to seizure onset. Patients with DHLs were more likely to be older in age, have atrial fibrillation, and coronary artery disease, and have more severe deep white matter hyperintensity or leukoaraiosis compared to patients without DHLs. Conclusion: DHLs detected on peri-ictal DWI may represent incidental acute cerebral microinfarcts in the aging brain, especially in patients with small vessel disease.
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12
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Arnold Fiebelkorn C, Vemuri P, Rabinstein AA, Mielke MM, Przybelski SA, Kantarci K, Jones DT, Brown RD, Knopman DS, Petersen RC, Jack CR, Graff-Radford J. Frequency of Acute and Subacute Infarcts in a Population-Based Study. Mayo Clin Proc 2018; 93:300-306. [PMID: 29426582 PMCID: PMC5837928 DOI: 10.1016/j.mayocp.2017.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/13/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the frequency of incidental acute or subacute cerebral infarction (CI) in a population-based study. PATIENTS AND METHODS We identified 2095 participants aged 50 to 98 years in the population-based Mayo Clinic Study of Aging from October 23, 2009, to October 5, 2016, with a usable diffusion tensor imaging (DTI) sequence (total scans=3230). Acute and subacute infarcts were identified by neuroradiologists. For each participant, vascular risk factors, medications, clinical symptoms, and neurological examination near the time of the CI were abstracted from the medical record. The probable etiologic mechanism for the CI was determined. RESULTS Nine CIs were identified with a frequency of 0.28% among individual magnetic resonance imaging (MRI) scans and 0.43% among unique individuals. Infarctions were detected in 0.097% of scans from participants younger than 70 years and in 0.36% of scans of those 70 years or older. Six CIs were acute, and 3 were subacute. Most participants with infarcts were men (78%), with a mean age of 76.9±6.74 years. All were asymptomatic at the time of CI detection. The probable mechanisms of CI were small vessel (n=6), cardioembolic (n=2), and cryptogenic (n=1). CONCLUSION Acute and subacute cerebral infarcts occur as incidental findings in approximately 1 in 230 people aged 50 to 98 years, particularly in elderly men and those with vascular risk factors. As brain MRI becomes more widely used, incidentally detected acute or subacute infarcts will provide an opportunity to improve stroke prevention.
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Affiliation(s)
| | | | | | - Michelle M Mielke
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN; Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN
| | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic and Foundation, Rochester, MN
| | - David T Jones
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
| | - Robert D Brown
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
| | - David S Knopman
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN
| | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic and Foundation, Rochester, MN
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13
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Komatsu K, Mikami T, Noshiro S, Miyata K, Wanibuchi M, Mikuni N. Reversibility of White Matter Hyperintensity by Revascularization Surgery in Moyamoya Disease. J Stroke Cerebrovasc Dis 2016; 25:1495-502. [PMID: 27038979 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND White matter lesions (WMLs) indicate progressive cerebral small vessel disease and are frequently observed in aging people and stroke patients. The purpose of this study was to evaluate WMLs and the influence of revascularization surgery for WMLs in patients with moyamoya disease. METHODS A total of 42 hemispheres in 21 patients with moyamoya disease were included in this analysis. WMLs were detected on fluid-attenuated inversion recovery (FLAIR) imaging in 24 hemispheres. The distribution pattern of WMLs was categorized. WMLs were measured by manually creating a region of interest, and the total WML volume in the hemisphere was estimated and compared with the control group. Clinical features of patients with WMLs and postoperative changes were analyzed. RESULTS The total WML volume in moyamoya disease was significantly higher than that of controls (P = .014). WMLs were observed in the internal watershed zone, especially in the watershed zone between the anterior cerebral artery and the middle cerebral artery. Patients with WMLs had significantly higher magnetic resonance angiography scores compared with controls (P = .015). A given patient's total WML volume per hemisphere was significantly decreased after surgery (P = .001). CONCLUSIONS WMLs on FLAIR imaging increase in patients with moyamoya disease and are reversible by revascularization surgery. Improvement of cerebral blood flow is partly related to the decrease in WMLs. The present results provide insight into the potential role of revascularization surgery.
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Affiliation(s)
- Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Shouhei Noshiro
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | | | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
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14
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van Rooij FG, Vermeer SE, Góraj BM, Koudstaal PJ, Richard E, de Leeuw FE, van Dijk EJ. Diffusion-weighted imaging in transient neurological attacks. Ann Neurol 2015; 78:1005-10. [DOI: 10.1002/ana.24539] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/18/2015] [Accepted: 10/03/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Frank G. van Rooij
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Sarah E. Vermeer
- Department of Neurology; Rijnstate Hospital; Arnhem the Netherlands
| | - Bozena M. Góraj
- Department of Radiology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Diagnostic Imaging; Medical Center of Postgraduate Education; Warsaw Poland
| | - Peter J. Koudstaal
- Department of Neurology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Edo Richard
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
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15
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Saini M, Suministrado MSP, Hilal S, Dong YH, Venketasubramanian N, Ikram MK, Chen C. Prevalence and Risk Factors of Acute Incidental Infarcts. Stroke 2015; 46:2722-7. [DOI: 10.1161/strokeaha.115.009963] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/22/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Monica Saini
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Ma Serrie P. Suministrado
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Saima Hilal
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Yan Hong Dong
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Narayanaswamy Venketasubramanian
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Mohammad K. Ikram
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
| | - Christopher Chen
- From the Department of Pharmacology, National University of Singapore, Singapore, Singapore (M.S., M.S.P.S., S.H., Y.H.D., C.C.); Department of Medicine, Changi General Hospital, Singapore, Singapore (M.S.); Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore (M.S.P.S., S.H., Y.H.D., N.V., M.K.I., C.C.); Raffles Neuroscience Centre, Department of Neurology, Raffles Hospital, Singapore, Singapore (N.V.); Singapore Eye Research Institute, Singapore National Eye
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16
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Auriel E, Westover MB, Bianchi MT, Reijmer Y, Martinez-Ramirez S, Ni J, Van Etten E, Frosch MP, Fotiadis P, Schwab K, Vashkevich A, Boulouis G, Younger AP, Johnson KA, Sperling RA, Hedden T, Gurol ME, Viswanathan A, Greenberg SM. Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging. Stroke 2015; 46:2129-35. [PMID: 26159796 DOI: 10.1161/strokeaha.115.009208] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microinfarcts (CMI) are important contributors to vascular cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. We aim to describe a mathematical method for estimating total number of CMI based on the presence of incidental DWI lesions. METHODS We reviewed magnetic resonance imaging scans of subjects with cognitive decline, cognitively normal subjects and previously reported subjects with past intracerebral hemorrhage (ICH). Based on temporal and spatial characteristics of DWI lesions, we estimated the annual rate of CMI needed to explain the observed rate of DWI lesion detection in each group. To confirm our estimates, we performed extensive sampling for CMI in the brain of a deceased subject with past lobar ICH who found to have a DWI lesion during life. RESULTS Clinically silent DWI lesions were present in 13 of 343 (3.8%) cognitively impaired and 10 of 199 (5%) cognitively intact normal non-ICH patients, both lower than the incidence in the past ICH patients (23 of 178; 12.9%; P<0.0006). The predicted annual incidence of CMI ranges from 16 to 1566 for non-ICH and 50 to 5041 for ICH individuals. Histological sampling revealed a total of 60 lesions in 32 sections. Based on previously reported methods, this density of CMI yields an estimated total brain burden maximum likelihood estimate of 9321 CMIs (95% confidence interval, 7255-11 990). CONCLUSIONS Detecting even a single DWI lesion suggests an annual incidence of hundreds of new CMI. The cumulative effects of these lesions may directly contribute to small-vessel-related vascular cognitive impairment.
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Affiliation(s)
- Eitan Auriel
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - M Brandon Westover
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Matt T Bianchi
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Yael Reijmer
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Sergi Martinez-Ramirez
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Jun Ni
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Ellis Van Etten
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Matthew P Frosch
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Panagiotis Fotiadis
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Kris Schwab
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Anastasia Vashkevich
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Grégoire Boulouis
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Alayna P Younger
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Keith A Johnson
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Reisa A Sperling
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Trey Hedden
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - M Edip Gurol
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Anand Viswanathan
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.)
| | - Steven M Greenberg
- From the Department of Neurology, J. Philip Kistler Stroke Research Center (E.A., M.B.W., M.T.B., Y.R., S.M.-R., J.N., E.V.E., P.F., K.S., A. Vashkevich, G.B., M.E.G., A. Viswanathan, S.M.G.) and Department of Pathology, Neuropathology Service, C.S. Kubik Laboratory for Neuropathology (M.P.F.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (A.P.Y., K.A.J., R.A.S., T.H.); and Department of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (R.A.S.).
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Batool S, O'Donnell M, Sharma M, Islam S, Dagenais GR, Poirier P, Lear SA, Wielgosz A, Teo K, Stotts G, McCreary CR, Frayne R, DeJesus J, Rangarajan S, Yusuf S, Smith EE. Incidental magnetic resonance diffusion-weighted imaging-positive lesions are rare in neurologically asymptomatic community-dwelling adults. Stroke 2014; 45:2115-7. [PMID: 24923720 DOI: 10.1161/strokeaha.114.005782] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Incidental magnetic resonance diffusion-weighted imaging (DWI)-positive lesions, considered to represent small acute infarcts, have been detected in patients with cerebral small vessel diseases or cognitive impairment, but the prevalence in the community population is unknown. METHODS DWI sequences collected in 793 participants in the Prospective Urban Rural Epidemiological (PURE) study were reviewed for DWI lesions consistent with small acute infarcts. RESULTS No DWI-positive lesions were detected (0%, 95% confidence interval, 0-0.5). CONCLUSIONS DWI-positive lesions are rare in an asymptomatic community population. The prevalence of DWI-positive lesions in the community seems to be lower than in patients with cerebral amyloid angiopathy, intracerebral hemorrhage, or cognitive impairment.
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Affiliation(s)
- Saima Batool
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Martin O'Donnell
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Mukul Sharma
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Shofiqul Islam
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Gilles R Dagenais
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Paul Poirier
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Scott A Lear
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Andreas Wielgosz
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Koon Teo
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Grant Stotts
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Cheryl R McCreary
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Richard Frayne
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Jane DeJesus
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Sumathy Rangarajan
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Salim Yusuf
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.)
| | - Eric E Smith
- From the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (S.B., R.F., E.E.S.); Department of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (M.O., M.S., S.I., K.T., J.D., S.R., S.Y.); Quebec Heart and Lung Institute, Laval University, Quebec, Canada (G.R.D., P.P.); Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.); Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada (S.A.L.); The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada (A.W., G.S.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (C.R.M., R.F., E.E.S.); Seaman Family MR Research Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (R.F., E.E.S.).
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Behrouz R, Benbadis SR. Psychogenic Pseudostroke. J Stroke Cerebrovasc Dis 2014; 23:e243-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/03/2013] [Accepted: 11/11/2013] [Indexed: 11/25/2022] Open
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The use of multi b values diffusion-weighted imaging in patients with acute stroke. Neuroradiology 2013; 55:371-6. [DOI: 10.1007/s00234-012-1129-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/03/2012] [Indexed: 11/27/2022]
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Auriel E, Gurol ME, Ayres A, Dumas AP, Schwab KM, Vashkevich A, Martinez-Ramirez S, Rosand J, Viswanathan A, Greenberg SM. Characteristic distributions of intracerebral hemorrhage-associated diffusion-weighted lesions. Neurology 2012. [PMID: 23197745 DOI: 10.1212/wnl.0b013e318278b66f] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To determine whether small diffusion-weighted imaging (DWI) lesions occur beyond the acute posthemorrhage time window in patients with intracerebral hemorrhage (ICH) and to characterize their spatial distribution in patients with lobar and deep cerebral hemorrhages. METHODS In this cross-sectional study, we retrospectively analyzed 458 MRI scans obtained in the acute (≤ 7 days after ICH) or nonacute (>14 days after ICH) phases from 392 subjects with strictly lobar (n = 276) and deep (n = 116) ICH (48.7% women; mean age 72.8 ± 11.7 years). DWI, apparent diffusion coefficient maps, fluid-attenuated inversion recovery, and T2* MRIs were reviewed for the presence and location of DWI lesions. RESULTS We identified 103 DWI hyperintense lesions on scans from 62 subjects, located mostly in lobar brain regions (90 of 103, 87.4%). The lesions were not uniformly distributed throughout the brain lobes; patients with strictly lobar ICH had relative overrepresentation of lesions in frontal lobe, and patients with deep ICH in parietal lobe (p = 0.002). Although the frequency of DWI lesions tended to be greater on scans performed within 7 days after ICH (39 of 214, 18.2%), they continued at high frequency in the nonacute period as well (23 of 178, 12.9%, odds ratio 1.5, 95% confidence interval 0.86-2.6 for acute vs nonacute). There was also no difference in frequency of lesions on acute and nonacute scans among 66 subjects with MRIs in both time periods (8 of 66 acute, 10 of 66 nonacute, odds ratio 0.77, 95% confidence interval 0.25-2.4). CONCLUSIONS The high frequency of DWI lesions beyond the acute post-ICH period and their characteristic distributions suggest that they are products of the small vessel diseases that underlie ICH.
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Affiliation(s)
- Eitan Auriel
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
Background and Purpose—
The prevalence of silent brain infarcts varies from 8% to 28% in the general elderly population. Silent brain infarcts are associated with increased risk of subsequent stroke and cognitive dysfunction. By definition, silent strokes lack clinically overt stroke-like symptoms and fail to come to clinical attention; however, impaired recall of symptoms may be a potential confounder. Our aim is to report a series of patients with incidentally detected acute and subacute strokes and examine whether they were truly asymptomatic.
Methods—
Subjects included in this study were drawn from ongoing dementia research studies at the Memory Ageing and Cognition Center, in which all participants underwent a cranial MRI. Incidental hyperintense lesions on diffusion-weighted imaging with corresponding apparent diffusion coefficient defects indicative of acute/subacute silent stroke were identified. Clinical data for individuals with incidental hyperintense lesions on diffusion-weighted imaging were collated.
Results—
Six of 649 subjects had incidental hyperintense lesions on diffusion-weighted imaging; on retrospective questioning, 3 recalled symptoms temporally correlated with MRI lesions, which had been reported to but ignored by family members. Two subjects had focal neurological signs. A majority of the subjects with incidental hyperintense lesions on diffusion-weighted imaging had significant cognitive impairment.
Conclusions—
A significant number of strokes may be “silent” due to lack of awareness of stroke-like symptoms in the elderly and their families. Enhanced stroke prevention education strategies are needed for the elderly population and, in particular, for their families.
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Affiliation(s)
- Monica Saini
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
| | - Kamran Ikram
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
| | - Saima Hilal
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
| | - Anqi Qiu
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
| | - Narayanaswamy Venketasubramanian
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
| | - Christopher Chen
- From the Departments of Pharmacology (M.S., S.H., C.C.), Ophthalmology (K.I.), Bioengineering (A.Q.), NUS, Singapore; the Clinical Imaging Research Centre, National University of Singapore, Singapore (A.Q.); and the. Division of Neurology, University Medicine Cluster, NUS, Singapore (N.V.)
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Yamada K, Sakai K, Owada K, Mineura K, Nishimura T. Cerebral white matter lesions may be partially reversible in patients with carotid artery stenosis. AJNR Am J Neuroradiol 2010; 31:1350-2. [PMID: 20190206 DOI: 10.3174/ajnr.a1873] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Contrary to the common belief that age-related WMLs (also known as leukoaraiosis) are a progressive condition, a case of partial reversal of WMLs shortly after carotid artery stenting is described. A 75-year-old man presented with frequent TIAs, which were attributed to right ICA stenosis. He subsequently underwent successful carotid artery stenting. Follow-up MR imaging a week after the procedure showed improvement of WMLs in the right cerebral hemisphere. Pixel-by-pixel image analysis showed that the reversed WMLs tended to have higher lambda1 and lower signal intensity on b = 0 images compared with nonreversed lesions, but by only approximately 10%.
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Affiliation(s)
- Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi Hirokoji Agaru, Kamigyo-ku, Kyoto City, Kyoto, Japan.
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Prabhakaran S, Gupta R, Ouyang B, John S, Temes RE, Mohammad Y, Lee VH, Bleck TP. Acute Brain Infarcts After Spontaneous Intracerebral Hemorrhage. Stroke 2010; 41:89-94. [DOI: 10.1161/strokeaha.109.566257] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We aimed to determine the prevalence of acute brain infarcts using diffusion-weighted imaging (DWI) in patients with spontaneous intracerebral hemorrhage (ICH).
Methods—
We collected data on consecutive patients with spontaneous ICH admitted to our institution between August 1, 2006 and December 31, 2008 and in whom DWI was performed within 28 days of admission. Patients with hemorrhage attributable to trauma, tumor, aneurysm, vascular malformation, and hemorrhagic conversion of arterial or venous infarction were excluded. Restricted diffusion within, contiguous with, or immediately neighboring the hematoma or chronic infarcts was not considered abnormal. Using multivariable logistic regression, we evaluated potential predictors of DWI abnormality including clinical and radiographic characteristics and treatments. A probability value <0.05 was considered significant in the final model.
Results—
Among 118 spontaneous ICH patients (mean 59.6 years, 47.5% male, and 31.4% white) who also underwent MRI, DWI abnormality was observed in 22.9%. The majority of infarcts were small (median volume 0.25 mL), subcortical (70.4%), and subclinical (88.9%). Factors independently associated with DWI abnormality were prior ischemic stroke (
P
=0.002), MAP lowering by ≥40% (
P
=0.004), and craniotomy for ICH evacuation (
P
=0.001).
Conclusion—
We found that acute brain infarction is relatively common after acute spontaneous ICH. Several factors, including aggressive blood pressure lowering, may be associated with acute ischemic infarcts after ICH. These preliminary findings require further prospective study.
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Affiliation(s)
- Shyam Prabhakaran
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Rajesh Gupta
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Bichun Ouyang
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Sayona John
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Richard E. Temes
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Yousef Mohammad
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Vivien H. Lee
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
| | - Thomas P. Bleck
- From the Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill
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24
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Taher AT, Musallam KM, Nasreddine W, Hourani R, Inati A, Beydoun A. Asymptomatic brain magnetic resonance imaging abnormalities in splenectomized adults with thalassemia intermedia. J Thromb Haemost 2010; 8:54-9. [PMID: 19817994 DOI: 10.1111/j.1538-7836.2009.03651.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND A high incidence of thrombotic events in thalassemia intermedia (TI) patients led to the identification of a hypercoagulable state. Brain involvement has not been widely studied in TI, although limited reports confirm a low incidence of overt stroke and high incidence of silent brain infarcts. PATIENTS/METHODS This was a prospective study conducted on 30 adult, splenectomized TI patients. Patients were screened for absence of neurological signs or symptoms, and stroke-related risk factors. Patient charts were reviewed for demographics, duration since splenectomy, and any history of transfusion therapy. Blood samples were obtained for complete blood counts and serum ferritin. Direct determination of liver iron concentration (LIC) was performed by R2 magnetic resonance imaging (MRI). Brain MRI was performed on all patients, looking for ischemic lesions and/or atrophy. RESULTS The mean age of patients was 32.1 +/- 11 years (range, 18-54 years), with a male to female ratio of 13:17. Eighteen patients (60%) had evidence of one or more white matter lesions (WMLs) on brain MRI, all involving the subcortical white matter. Fourteen patients had evidence of multiple WMLs, with a mean of 5 +/- 10 lesions (range, 2 to > 40 lesions). The vast majority of patients (94%) had small (< 0.5 cm) to medium (0.5-1.5 cm) WMLs, with only one patient showing evidence of a large (> 1.5 cm) WML. Eleven patients (37%) had mild cerebral atrophy. On multivariate analysis only age and transfusion history were independently and significantly associated with the occurrence of zero, single or multiple WMLs. CONCLUSION WMLs and brain atrophy are a common finding in adult, splenectomized, TI patients. Increasing age and transfusion naivety are associated with a higher incidence and multiplicity of lesions.
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Affiliation(s)
- A T Taher
- Division of Hematology & Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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