Prevalence and Determinants of Subdiaphragmatic Visceral Infarction in Patients With Fatal Stroke

Abstract

Background and Purpose-Arterial thromboembolism is a common cause of both visceral and brain infarctions. Because the cause of brain infarction is unknown in up to 39% of patients, the discovery of subdiaphragmatic visceral infarction (SDVI) in this context is important, but its frequency is unknown. We therefore investigated the prevalence of SDVI in subjects who died from stroke. We also evaluated the yield of SDVI diagnosis for stroke subtyping. Methods-We performed a case-control study using a series of 815 consecutive autopsies of patients who had died from a neurological disease, including 350 with stroke (260 infarcts and 90 hemorrhages). We systematically assessed the presence of renal, splenic, and mesenteric infarction (no case of spinal cord was recorded) and analyzed their determinants in patients with stroke. Patients with other neurological diseases served as the control group. Results-Renal infarction was the most frequent SDVI (10.2%), whereas mesenteric infarction was rare (1.1%). At least one SDVI was found in 16.9% of patients with stroke (38.7% of patients with a cardioembolic stroke) and in 5.1% of patients with other neurological diseases (adjusted ORϭ2.12; 95% CIϭ1.08 to 4.16). Among patients with stroke, a significant heterogeneity in the prevalence of SDVI was found across etiological stroke subgroups with only three patients (3.3%) with hemorrhagic stroke having an SDVI (2 mesenteric and one renal infarction) compared with 56 patients (21.5%) with ischemic stroke (PϽ0.0001). Among patients with brain infarction and a SDVI, 76.8% had a definite cardiac source of embolism. Conclusions-In patients with fatal brain infarction, the prevalence of SDVI is higher than previously thought, especially in those with stroke attributed to cardiac emboli. Seeking SDVI may assist in the etiologic diagnosis of brain infarction

Percutaneous balloon mitral valvuloplasty under neuroprotection

“…Though experimental models of brain embolism do show a high incidence of anterior cerebral circulation localization, this in no way means that the posterior circulation is always spared . In addition, necropsy studies of patients with brain embolism of cardiac origin with fatal strokes nearly always show embolic infarcts in other organs, especially the spleen and kidneys . Also the time course of embolic stroke after the manipulation of thrombus by the hardware can be difficult to predict.…”

Relationship between Presence of Visceral Infarction and Functional Outcome among Patients with Acute Ischemic Stroke

“…Visceral infarctions are often incidentally detected in patients with acute ischemic stroke or TIA [1]. Among an autopsy study of patients with fatal ischemic stroke, onefifth had evidence of visceral infarctions; renal and splenic infarctions were the most frequent types of visceral infarctions [2]. Visceral infarctions may be a marker of a Cerebrovasc Dis 2020;49:316-320 DOI: 10.1159/000508826 central embolic source as they are more often detected in patients with cardioembolic stroke or embolic stroke of undetermined source [3].…”

Multiorgan With Renal Infarction Following Treatment of Cerebral Infarction

“…One of these, the atrial fibrillation is a common heart disease that causes thromboembolisms, and is a main cause of ischemic cerebral infarctions, as well as renal infarction, mesenteric infarction and splenic infarction, which was rarely reported [2]. Abboud et al [3] reports that among the 260 autopsies performed on patients expired by cerebral infarction, subdiaphragmatic visceral infarctions have been observed in 10.2%, with renal infarctions in 16.2% of these cases, being the most frequent. Abboud et al [3] recommends that additional studies should be evaluated on subdiaphragmatic visceral infarctions in cerebral infarction patients, as it is frequently associated, but often non-symptomatic and easily diagnostically overlook.…”

“…Abboud et al [3] reports that among the 260 autopsies performed on patients expired by cerebral infarction, subdiaphragmatic visceral infarctions have been observed in 10.2%, with renal infarctions in 16.2% of these cases, being the most frequent. Abboud et al [3] recommends that additional studies should be evaluated on subdiaphragmatic visceral infarctions in cerebral infarction patients, as it is frequently associated, but often non-symptomatic and easily diagnostically overlook. Abboud et al [3] recommends that additional studies should be evaluated on subdiaphragmatic visceral infarctions in cerebral infarction patient due to its frequent association, but often non-symptomatic and easy diagnosis are overlooked.…”

“…Abboud et al [3] recommends that additional studies should be evaluated on subdiaphragmatic visceral infarctions in cerebral infarction patients, as it is frequently associated, but often non-symptomatic and easily diagnostically overlook. Abboud et al [3] recommends that additional studies should be evaluated on subdiaphragmatic visceral infarctions in cerebral infarction patient due to its frequent association, but often non-symptomatic and easy diagnosis are overlooked.…”