Prevalence of subdiaphragmatic visceral infarction in cardioembolic stroke

Slaoui, Tarik; Klein, Isabelle; Guidoux, Céline; Cabrejo, Lucie; Meseguer, Elena; Abboud, Halim; Lavalllée, P.C.; Mazighi, Mikaël; Labreuche, Julien; Amarenco, Pierre

doi:10.1212/wnl.0b013e3181d76aaa

Cited by 12 publications

(10 citation statements)

References 5 publications

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“…Prior studies of abdominal magnetic resonance imaging in patients with cardioembolic stroke show a 20% prevalence of visceral infarcts. 3, 6 Our results build on these studies by demonstrating the prevalence of visceral infarction differs across ischemic stroke subtypes. We found no visceral infarcts among patients with lacunar stroke, supporting this stroke subtype as a distinct entity resulting from in-situ occlusion of the cerebral vasculature.…”

Section: Discussionsupporting

confidence: 65%

“…1 Emboli from a central source may cause limb, mesenteric, renal, and splenic infarcts. While symptomatic systemic infarcts are rare, 2 asymptomatic visceral infarcts are commonly found in patients with recent stroke, 3, 4 raising the possibility of a common embolic source. We hypothesized that visceral infarcts are more common in patients with cardioembolic and cryptogenic strokes than strokes due to small-vessel occlusion or large-artery atherosclerosis.…”

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confidence: 99%

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Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Finn

Hung

Patel

et al. 2018

Stroke

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Background and Purpose Most cryptogenic strokes are thought to have an embolic source. We sought to determine whether cryptogenic strokes are associated with visceral infarcts, which are usually embolic. Methods Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR), we selected those with a contrast-enhanced abdominal computed tomography (CT) scan within 1 year of admission. Our exposure variable was adjudicated stroke subtype per the TOAST classification. Our outcome was renal or splenic infarction, as assessed by a single radiologist blinded to stroke subtype. We used Fisher’s exact test and multiple logistic regression to compare the prevalence of visceral infarcts among cardioembolic strokes, strokes of undetermined etiology, and non-cardioembolic strokes (large- or small-vessel strokes). Results Among 227 patients with ischemic stroke and a contrast-enhanced abdominal CT scan, 59 had a visceral infarct (35 renal and 27 splenic). The prevalence of visceral infarction was significantly different among cardioembolic strokes (34.2%; 95% confidence interval [CI], 23.7-44.6%), strokes of undetermined etiology (23.9%; 95% CI, 15.0-32.8%), and strokes from large-artery atherosclerosis or small-vessel occlusion (12.5%; 95% CI, 1.8-23.2%) (P = 0.03). In multiple logistic regression models adjusted for demographics and vascular comorbidities, we found significant associations with visceral infarction for both cardioembolic stroke (odds ratio [OR], 3.5; 95% CI, 1.2-9.9) and stroke of undetermined source (OR, 3.3; 95% CI, 1.1-10.5) as compared with non-cardioembolic stroke. Conclusions The prevalence of visceral infarction differed significantly across ischemic stroke subtypes. Cardioembolic and cryptogenic strokes were associated with a higher prevalence of visceral infarcts than non-cardioembolic strokes.

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Section: Discussionsupporting

confidence: 65%

mentioning

confidence: 99%

Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Finn

Hung

Patel

et al. 2018

Stroke

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Introduction: Evidence of visceral infarction is often found in patients with acute ischemic stroke. It remains uncertain whether there exists a relationship between visceral infarction and functional outcomes among patients with stroke. Objective: The aim of this study was to evaluate whether evidence of visceral infarction is associated with functional outcomes among patients with stroke. Methods: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. Our outcome was ambulatory status at discharge from acute stroke hospitalization, categorized as walking without assistance, walking with assistance, and unable to walk. We used ordinal logistic regression to examine the association between visceral infarction and discharge ambulatory status after adjustment for demographics, stroke risk factors, stroke severity (NIH Stroke Scale), and stroke subtype. Results: Among 2,116 ischemic stroke patients registered in CAESAR from 2011 to 2016, 259 had contrast-enhanced abdominal computed tomographic imaging, of whom 48 (19%) had evidence of visceral infarction. After adjustment for demographics, stroke risk factors, stroke severity, and stroke subtype, the presence of visceral infarction was associated with a worse ambulatory status at discharge (global OR for better ambulatory status, 0.4; 95% CI, 0.2-1.0, p = 0.046). Conclusions: We found that the presence of visceral infarction was associated with poor functional outcomes at the time of hospital discharge. These findings suggest that such findings are not necessarily benign and are at the least a marker of poor outcomes.

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“…Atrial fibrillation (AF) is the commonest cardiac arrhythmia that increases the risk of thromboembolism, thereby subsequently leading to cerebral infarctions and the infarctions of other major visceral organs. Patients with cardioembolic stroke have higher likelihood of developing infarctions of visceral organs below the diaphragm with renal infarction being more common [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Acute renal infarction and cardioembolic stroke in a patient with atrial fibrillation and hyperthyroid-induced cardiomyopathy: a case report

et al. 2016

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BackgroundAcute renal infarction is a rare entity with varied misleading manifestations resulting in diagnostic delay, misdiagnosis, and treatment leading to renal damage.Case presentationWe report the case of a 28-year-old Dalit Nepalese man who presented with sudden onset occipital headache and later developed severe left flank pain. He was diagnosed with posterior cerebral infarction with hemorrhagic transformation and a subsequent acute renal infarction with atrial fibrillation and hyperthyroid-induced cardiomyopathy. He was managed with oral anticoagulant and antithyroid drug.ConclusionA high index of suspicion of acute renal infarction is required in patients with risk factors of thrombosis presenting sudden onset flank pain.

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Prevalence of subdiaphragmatic visceral infarction in cardioembolic stroke

Abstract: One in 5 patients with nonfatal cardioembolic stroke or TIA may be associated with subdiaphragmatic visceral infarction (SDVI). Further study should evaluate the frequency of SDVI in patients with stroke of unknown cause.

Cited by 12 publications

References 5 publications

Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Relationship Between Visceral Infarction and Ischemic Stroke Subtype

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

Acute renal infarction and cardioembolic stroke in a patient with atrial fibrillation and hyperthyroid-induced cardiomyopathy: a case report

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