Acute Cerebral Microinfarcts in Acute Ischemic Stroke: Imaging and Clinical Significance

Abstract

<b><i>Background:</i></b> Limited data exist on the significance of acute cerebral microinfarcts (A-CMIs) in the context of acute ischemic stroke (AIS). We aimed to determine the profile and prognostic significance of A-CMIs on magnetic resonance imaging (MRI) in patients presenting with AIS. <b><i>Methods:</i></b> A prospective single-center series of patients with AIS who had 3T MRIs between March 2013 and December 2019. The presence, number, and location of A-CMIs on diffusion-weighted imaging, and markers of cerebral small vessel disease (CSVD), macroinfarcts features, and etiology were classified as cardioembolism (CE) or large artery atherosclerosis (LAA) or none. <b><i>Results:</i></b> Among 273 patients, A-CMIs were detected in 130 patients (47.6%), of whom cortical A-CMIs were found in 95 (73.0%) patients. Patients with A-CMIs were significantly older, less likely to have diabetes mellitus, and more likely to have atrial fibrillation and an embolic source (CE or LAA) compared to other patients. Patients with A-CMI had a higher frequency of macroinfarcts (diameter >20 mm), more often multiple and distributed in single or multiple vessel territories than other patients. An embolic source (LAA or CE) was independently associated with cortical A-CMIs (LAA adjusted odds ratio [aOR] 4.0 95% confidence interval [CI] 1.6–9.5; CE aOR 2.5, 95% CI 1.1–5.6), whereas lacunes were independently related to subcortical A-CMIs (aOR 2.6, 95% CI 1.2–5.8). <b><i>Conclusions:</i></b> We have shown A-CMIs occur in cortical and subcortical regions in nearly half of AIS patients, where microembolism and CSVD are, respectively, the key presumed etiological mechanism.

Echocardiographic correlates of MRI imaging markers of cerebral small-vessel disease in patients with atrial-fibrillation-related ischemic stroke

“…The data that support the findings of this cross-sectional study is available from the Chengdu stroke registry, an ongoing prospective hospital-based database ( 8 ). We defined AF-related ischemic stroke when the patients had a cardioembolic stroke with AF.…”

“…The data that support the findings of this cross-sectional study is available from the Chengdu stroke registry, an ongoing prospective hospital-based database (8). We defined AF-related ischemic stroke when the patients had a cardioembolic stroke Abbreviations: AF, Atrial fibrillation; CSVD, cerebral small vessel disease; WMH, white matter hyperintensity; CMBs, cerebellar microbleeds; LA, left atrium; LV, left ventricular; EPVS, enlarged perivascular spaces; BG-EPVS, enlarged perivascular spaces severity in basal ganglia; CSO…”

Lung cancer is associated with acute ongoing cerebral ischemia: A population-based study

“…1 Special MRI sequence, the diffusion-weighted imaging (DWI), can detect CMI, but only within a limited time period of 5-14 days following their formation. 2 CMI can be detected in different clinical settings such as cerebral small vessel disease (CSVD), 3,4 ipsilateral carotid occlusion 5 or stenosis, 6 acute ischemic stroke, 7 and cardioembolism. 8 A randomly detected CMI on MRI implies the annual incidence of hundreds of new CMI 9 and may therefore serve as a strong predictor for future stroke and cognitive decline.…”