Objectives:We aimed to assess frequencies and radiological aspects of single-and multiterritory clinical manifestation among patients with acute cerebral infarcts in multiple arterial territories (MACI). Materials & methods:We retrospectively reviewed admission records and diffusionweighted magnetic resonance imaging of patients with MACI admitted to our stroke unit between 2006 and 2017. MACI was defined as acute cerebral ischemic lesions in at least two out of three arterial cerebral territories, that is, the left anterior, right anterior and the bilateral posterior territory. Patients with single-and multiterritory clinical manifestation were then compared for topographical distribution of the ischemic lesions, the number of ischemic lesions, and The Oxfordshire Community Stroke Project classification.Results: Out of 311 patients with MACI, 222 (71.4%) presented with single-territory clinical manifestation. Involvement of the left hemisphere (OR = 0.37, 95% CI 0.16-0.82), less than five ischemic lesions (OR = 0.58, 95% CI 0.35-0.97), and partial anterior circulation infarct clinical stroke syndrome (OR = 0.57, 95% CI 0.34-0.97) were associated with single-territory clinical manifestation. Involvement of all three territories (OR = 2.58, 95% = 1.48-4.50), more than 10 ischemic lesions (OR = 2.30, 95% CI 1.32-4.01) and total anterior circulation infarct clinical stroke syndrome (OR = 3.31, 95% CI 1.39-7.86) were associated with multiterritory clinical manifestation. Conclusion:Most patients with MACI present with single-territory clinical manifestation on admission. Diffusion-weighted magnetic resonance imaging is therefore necessary for a definite diagnosis. K E Y W O R D Sdiffusion-weighted imaging, multiple stroke, neurological manifestation, symptoms and signsThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Background: Carotid artery atherosclerosis is a major risk factor for ischemic stroke. This risk is related to plaque vulnerability and is characterized by plaque morphology, intraplaque neovascularization, and cerebral microembolization. Advanced neurosonology can identify vulnerable plaques and aid in preventing subsequent stroke. We aimed to assess the time course of cerebral microembolization and intraplaque neovascularization during 6 months of follow-up and to explore the utility of advanced neurosonology in patients with acute cerebral ischemia.Methods: Fifteen patients with acute cerebral ischemia and carotid artery plaques underwent comprehensive extra- and intracranial ultrasound examinations, including microemboli detection and contrast-enhanced ultrasound. The examinations were repeated after 3 and 6 months.Results: We examined 28 plaques in 15 patients. The ultrasonographic features of plaque vulnerability were frequent in symptomatic and asymptomatic plaques. There were no significant differences in stenosis degree, plaque composition, plaque surface, neovascularization, or cerebral microembolization between symptomatic and asymptomatic plaques, but symptomatic plaques had a higher number of vulnerable features. None of the patients had recurrent clinical stroke or transient ischemic attack during the follow-up period. We observed a decrease in cerebral microembolization at 6 months, but no significant change in intraplaque neovascularization.Conclusions: In patients with acute cerebral ischemia and carotid artery plaques, cerebral microembolization decreased during 6 months of follow-up, indicating plaque stabilization.Clinical Trial Registration:ClinicalTrial.gov, identifier NCT02759653.
Lars Thomassen er spesialist i nevrologi, professor emeritus ved Universitetet i Bergen, tidligere overlege ved Nevrologisk avdeling og nå forsker ved Nevroklinikken, Haukeland universitetssjukehus. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Anne e Fromm er ph.d. (ultralyddiagnostikk), europeisk M.Sc. (stroke medicine), spesialist i nevrologi og overlege ved Nevrologisk avdeling, Haukeland universitetssjukehus. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Sander Aarli er ph.d.-kandidat ved Universitetet i Bergen og arbeider med ultralydovervåking ved Nevrologisk avdeling, Haukeland universitetssjukehus. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nicola Logallo er ph.d. (transkranial ultralyddiagnostikk), europeisk M.Sc. (stroke medicine), spesialist i nevrologi og overlege ved Nevrokirurgisk overvåkingsavdeling, Haukeland universitetssjukehus. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.
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