Relationship Between Visceral Infarction and Ischemic Stroke Subtype

Abstract

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.

Clinical Impact of Thrombophilia Screening in Young Adults with Ischemic Stroke

“…Characteristics of CAESAR have been published previously. (17) Patients were included if they were 18 to 65 years of age, were hospitalized for an acute ischemic stroke of any subtype from 2011 through 2015, and had any laboratory testing for thrombophilia within 6 months of index stroke. Standard thrombophilia testing at our institution includes serum evaluation for antiphospholipid syndrome comprising the anticardiolipin and anti-beta-2 glycoprotein-1 antibodies (IgG and IgM isotypes) and lupus anticoagulant; Factor V Leiden gene mutation; prothrombin gene G202010A mutation; protein C, protein S, and antithrombin deficiencies; increased homocysteine; and methylenetetrahydrofolate reductase (MTHFR) gene mutation ( Table 1).…”

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

“… 4 , 5 , 11 , 16 Many of these patients were also found to have other systemic evidence of thromboembolic disease 39 , 40 and visceral infarction—a phenomenon that is known to be associated with cardioembolic and cryptogenic strokes. 41 …”

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. Recently, we have reported that visceral infarctions are more often detected in patients with cardioembolic or cryptogenic stroke subtypes [3]. Little is known about the mechanisms and significance of these commonly detected lesions.…”

“…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]. Despite their frequency, the clinical significance of visceral infarctions remains poorly understood.…”