Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging

Roh, Jae-Kyu; Kang, Dong‐Wha; Lee, Seung‐Hoon; Yoon, Byung‐Woo; Chang, Kee-Hyun

doi:10.1161/01.str.31.3.688

Cited by 167 publications

(176 citation statements)

References 46 publications

Supporting

Mentioning

155

Contrasting

Order By: Relevance

“…54 A larger study evaluated acute multiple brain infarcts as seen on DWI within 4 days of symptoms onset with relation to stroke mechanism in an Asian population; large-artery occlusion was significantly associated with multiple lesions in one or both sides of the anterior circulation or in the posterior circulation; cardioembolism was significantly associated with lesions in both anterior and posterior circulations; and small vessel occlusions were significantly and exclusively related to multiple lesions in both sides of the anterior circulation. 55 Similar results have been replicated in a North American population. 56 DWI bright signals do not necessarily represent irreversibly infarcted tissue but reflect redistribution of water from the extracellular to the intracellular space in ischemic tissue.…”

Section: Magnetic Resonance Imagingsupporting

confidence: 57%

Neuroimaging of ischemia and infarction

Camargo

Koroshetz

2005

Neurotherapeutics

View full text Add to dashboard Cite

Summary:Since the introduction of thrombolytic therapy as the foundation of acute stroke treatment, neuroimaging has rapidly advanced to empower therapeutic decision making. Diffusionweighted imaging is the most sensitive and accurate method for stroke detection, and, allied with perfusion-weighted imaging, provides information on the functional status of the ischemic brain. It can also help to identify a response to thrombolytic and neuroprotective therapies. Additionally, multimodal magnetic resonance imaging, including magnetic resonance angiography, offers information on stroke mechanism and pathophysiology that can guide long-term medical management. Multimodal computed tomography is a comprehensive, cost-effective, and safe stroke imaging modality that can be easily implemented in the emergency ward and that offers fast and reliable information with respect to the arterial and functional status of the ischemic brain. Accessibility, contraindications, cost, speed, and individual patient-determined features influence which is the best imaging modality to guide acute stroke management.

show abstract

Section: Magnetic Resonance Imagingsupporting

confidence: 57%

Neuroimaging of ischemia and infarction

Camargo

Koroshetz

2005

Neurotherapeutics

View full text Add to dashboard Cite

show abstract

“…Bilateral disease, conversely, is a marker for severe arteriosclerosis and/or cardiac disease (Roh et al, 2000;Kang et al, 2003) with a high risk of cardiovascular death (Kaarisalo et al, 1997;Wong and Li, 2003;Stollberger et al, 2004). Conversely, bilateral cerebrovascular disease represents more extensive disease that is associated with an increased risk to develop seizures or SE (Arboix et al, 1997;Labovitz et al, 2001).…”

Section: Factors Contributing To the Increased Case Fatality After Sementioning

confidence: 99%

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Knake¹,

Rochon

Fleischer³

et al. 2006

Epilepsia

View full text Add to dashboard Cite

Summary:Purpose: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group).Methods: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions.Results: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p = 0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p = 0.0392].Conclusions: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower. Key Words: Long-term mortality-Case fatality-Risk factors-Causes of death-Status epilepticus.Status epilepticus (SE) is a major neurologic emergency with an incidence of ∼20/100,000 for the white population in industrialized countries. Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al., 1994;Towne et al., 1994;Logroscino et al., 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al., 1995;Logroscino et al., 1997;Lowenstein and Alldredge, 1998;Knake et al., 2001;Rosenow et al., 2002;Wu et al., 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease. and duration of SE were main predictors of increased short-term mortality (Hauser, 1990;Lowenstein and Alldredge, 1998;Wu et al., 2002 In contrast, available reports examining long-term mortality after SE are sparse. Only one recent study systematically analyzed mortality at more than 10 years after the first episode of SE and found an increased long-term mortality of 43%, significantly associated with older age, status duration >24 h, acute symptomatic etiology including stroke, and myoclonic SE caused by hypoxic brain injury (Logroscino et al., 2002).The authors concluded that SE alone...

show abstract

“…Previous studies focusing on multiple, acute brain infarcts [14][15][16][17][18][19][20][21][22] have reported widely variable results, attributing infarcts to an embolic source in 28 to 100 percent, with a cardiac or aortic source found in 18 to 52 percent of patients. In these studies, however, a large proportion (27 to 40 percent) of multiple infarcts have been linked speculatively, to emboli from proximal large artery stenotic lesions [14][15][16][17][18][19][20][21][22]. However, it is implausible that emboli could arise near simultaneously from different proximal arteries or traverse from one proximal artery to circulations in both hemispheres or from carotid to vertebrobasilar circulation.…”

Section: Discussionmentioning

confidence: 99%

Can Transient Drop in Blood Pressure in High-Risk Hypertensive Patients Cause Small Cerebral Infarcts?

Bhagavati

Choi

2013

ISRN Stroke

View full text Add to dashboard Cite

Background. Multiple, simultaneous, acute cerebral infarcts in different arterial territories are usually secondary to embolic occlusion of multiple cerebral arteries. We observed, however, that no cardiac or aortic source could be found in many of these patients. We therefore undertook this study to attempt to identify other factors that may be important in the causation of these infarcts. Materials and Methods. We performed a five-year retrospective review of all patients with multiple, near simultaneous, acute cerebral infarcts detected on diffusion-weighted MRI scans. Results. We identified 78 patients with acute infarcts, in different cerebral arterial territories. We found a cardiac embolic source in 15 (19 percent) patients. Forty-one patients (53%) had no obvious cause for their infarcts after detailed cardiovascular and hematological evaluation. In 16 of these patients (20% of all 78 patients), all with a history of chronic hypertension who had multiple, acute, small (<2 cms), deep subcortical or superficial cortical infarcts (and most, 93%, with extensive evidence of chronic small vessel disease on MRI FLAIR images), blood pressure was low or normal on initial presentation (mean arterial pressure, MAP: 85 ± 11.4 mm Hg). Analysis of the last prestroke blood pressure, within the previous 1 to 11 days available in 13 of 16 patients, revealed much higher BP (MAP: 113.6 ± 11.3 mm Hg), indicating a mean drop of 25.1 percent (range 11 to 44 percent). Two weeks after the stroke, blood pressure had risen again to greater than 160/100 mm Hg (MAP: 128.2 ± 14.3). Conclusion. Our study suggests that transient drop in blood pressure in high-risk hypertensive patients with severe, small vessel disease may sometimes result in small, cerebral infarcts. More research is needed to further clarify and confirm this possibility.

show abstract

Significance of Acute Multiple Brain Infarction on Diffusion-Weighted Imaging

Cited by 167 publications

References 46 publications

Neuroimaging of ischemia and infarction

Neuroimaging of ischemia and infarction

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Can Transient Drop in Blood Pressure in High-Risk Hypertensive Patients Cause Small Cerebral Infarcts?

Contact Info

Product

Resources

About