1
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Coexistent cerebral small vessel disease and multiple infarctions predict recurrent stroke. Neurol Sci 2022; 43:4863-4874. [PMID: 35364769 PMCID: PMC9349065 DOI: 10.1007/s10072-022-06027-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/18/2022] [Indexed: 11/10/2022]
Abstract
Background and purpose To investigate the association of different status of cerebral small vessel disease (CSVD) and infarction number with recurrence after acute minor stroke and transient ischaemic attack (TIA). Methods This study was a post hoc analysis of the Clopidogrel in High-risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial, and includes 886 patients with acute minor stroke and TIA. The status of CSVD and infarction number was recorded for each individual. Infarction number were classified as multiple acute infarctions (MAIs≥2), single acute infarction (SAI =1), and non-acute infarction (NAI =0). The CSVD burden were grouped into non-CSVD (0 score) and CSVD (1–4 score). The primary outcome was a recurrent stroke at the 1-year follow-up. The secondary outcomes were recurrent ischaemic stroke, composite vascular event (CVE), and TIA. We analyzed the relationships between different status of CSVD burden and infarction pattern with the risk of outcomes using multivariable Cox regression models. Results Among all 886 patients included in present analysis, recurrent stroke was occurred in 93 (10.5%) patients during 1-year follow-up. After adjusted for all potential covariates, compared with patients with non-CSVD and NAI, patients with CSVD and MAIs were associated with approximately 9.5-fold increased risk of recurrent stroke at 1 year (HR 9.560, 95% CI 1.273–71.787, p=0.028). Similar results observed in ischaemic stroke and CVE. Conclusion The status of CSVD and infarction number predicted recurrent stroke in patients with acute minor stroke and TIA, especially for those with coexistent CSVD and MAIs. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06027-6.
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2
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Zhang K, Fang Y, Fan H, Ren J, Liu C, Liu T, Wang Y, Li Y, Li J, Meng J, Qian L, Li X, Wu X, Niu X. A nomogram for predicting the in-hospital risk of recurrence among patients with minor non-cardiac stroke. Curr Med Res Opin 2022; 38:487-499. [PMID: 35119325 DOI: 10.1080/03007995.2022.2038488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with minor stroke suffer a substantial risk of further recurrences, especially in the first two weeks. We aimed to develop and validate a prognostic nomogram to predict in-hospital stroke recurrence among patients with acute minor stroke. METHODS A total of 1326 patients with minor non-cardiac stroke (NIHSS) ≤5) from three centers were divided into development cohort (1016 patients from two centers) and validation cohort (310 patients from another center). Recurrent stroke was defined as a new ischemic stroke. A logistic regression model was employed to develop the nomogram to predict in-hospital stroke recurrence in patients with minor stroke using demographic, medical and imaging information. We then validated the nomogram externally. The predictive discrimination and calibration of the nomogram were assessed in the development and validation cohorts by area under the curve (AUC) and calibration plots. RESULTS During a median length of stay of 12 days, stroke recurrence occurred in 34 patients (3.3%). Predictors of in-hospital recurrence included prior history of transient ischemic attack, baseline NIHSS score, multiple infarctions, and carotid stenosis. The clinical and imaging-based nomogram B demonstrated adequate calibration and discrimination (AUC = 0.777), which was validated among 273 patients in a separate validation cohort (AUC = 0.753). Our clinical-imaging based nomogram was determined to be superior to the clinical-based nomogram and the RRE90 score in terms of discrimination. CONCLUSION A prognostic nomogram that integrates clinical and imaging information to predict the in-hospital risk of stroke recurrence among patients after acute minor stroke was constructed and validated externally. The nomogram demonstrated adequate calibration and discrimination in both the development and validation cohort.
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Affiliation(s)
- Kaili Zhang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalan Fang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Haimei Fan
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Neurology of The General Hospital of TISCO Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jing Ren
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chang Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingting Liu
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongle Wang
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanan Li
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Li
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jingwen Meng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lixia Qian
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinyi Li
- Department of Neurology of Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Wu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Niu
- Department of Neurology of The First Hospital of Shanxi Medical University, Taiyuan, China
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3
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Choi Y, Hwang EJ, Nam Y, Choi HS, Jang J, Jung SL, Ahn KJ, Kim BS. Analysis of Apparent Diffusion Coefficients of the Brain in Healthy Controls: A Comparison Study between Single-Shot Echo-Planar Imaging and Read-out-Segmented Echo-Planar Imaging. Korean J Radiol 2020; 20:1138-1145. [PMID: 31270977 PMCID: PMC6609426 DOI: 10.3348/kjr.2018.0899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/05/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To compare apparent diffusion coefficients (ADCs) of brain segments by using two diffusion-weighted imaging acquisition modes, single-shot echo-planar imaging (ss-EPI) and read-out-segmented echo-planar imaging (rs-EPI), and to assess their correlation and agreement in healthy controls. MATERIALS AND METHODS T2-weighted (T2W) images, rs-EPI, and ss-EPI of 30 healthy subjects were acquired using a 3T magnetic resonance scanner. The T2W images were co-registered to the rs-EPI and ss-EPI, which were then segmented into the gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) to generate masking templates. ADC maps of rs-EPI and ss-EPI were also segmented into the GM, WM, and CSF by using the generated templates. ADCs of rs-EPI and ss-EPI were compared using Student's t tests and correlated using Pearson's correlation coefficients. Bland-Altman plots were used to assess the agreement between acquisitions. RESULTS ADCs of rs-EPI and ss-EPI were significantly different in the GM (p < 0.001) and WM (p < 0.001). ADCs showed high agreement and correlation in the whole brain and CSF (r > 0.988; p < 0.001). ADC of the WM showed the least correlation (r = 0.894; p < 0.001), and ADCs of the WM and GM showed poor agreement. Pearson's correlation equations for each brain segment were y = 1.1x - 59.4 (GM), y = 1.45x - 255 (WM), and y = 0.98x - 63.5 (CSF), where x and y indicated ADCs of rs-EPI and ss-EPI, respectively. CONCLUSION While ADCs of rs-EPI and ss-EPI showed high correlation and agreement in the whole brain and CSF, ADCs of the WM and GM showed significant differences and large variability, reflecting brain parenchymal inhomogeneity due to different regional microenvironments. ADCs of different acquisition methods should be interpreted carefully, especially in intra-individual comparisons.
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Affiliation(s)
- Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Eo Jin Hwang
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yoonho Nam
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyun Seok Choi
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea. .,Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea.
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea.
| | - Kook Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea.
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, Seoul, Korea.
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4
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Jing J, Meng X, Zhao X, Liu L, Wang A, Pan Y, Li H, Wang D, Johnston SC, Wang Y, Wang Y. Dual Antiplatelet Therapy in Transient Ischemic Attack and Minor Stroke With Different Infarction Patterns: Subgroup Analysis of the CHANCE Randomized Clinical Trial. JAMA Neurol 2019; 75:711-719. [PMID: 29582084 DOI: 10.1001/jamaneurol.2018.0247] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Infarction patterns may serve as important imaging markers to assess the probability of stroke recurrence in transient ischemic attack (TIA) and minor stroke. However, it is unclear whether patients with different infarction patterns benefit differently from dual antiplatelet therapy. Objectives To investigate whether infarction patterns can stratify the risk of recurrent stroke and whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone are consistent in different infarction patterns after TIA or minor stroke. Design, Setting, and Participants In this prespecified imaging substudy of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) randomized clinical trial, a total of 1342 patients with noncardioembolic TIA or minor stroke at 45 sites of CHANCE from October 1, 2009, to July 30, 2012, were included in this substudy. The final analysis was conducted on July 30, 2016, and included 1089 patients with required magnetic resonance imaging sequences. Infarction patterns were grouped into multiple acute infarctions (MAIs), single acute infarction (SAI), and no acute infarction (NAI) according to diffusion-weighted imaging. Main Outcomes and Measures Primary and secondary efficacy outcomes were stroke recurrence and new clinical vascular event after 3 months, respectively. The safety outcome was moderate to severe bleeding risk after 3 months. Results Among 1089 patients, the mean (SD) age was 63.1 (10.7) years and 731 patients (65%) were men. Patients with MAIs (hazard ratio [HR], 5.8; 95% CI, 2.2-15.1; P < .001) and SAI (HR, 3.9; 95% CI, 1.5-10.5; P = .007) had higher risk of recurrent stroke than those with NAI after adjustment for potential confounders at 3-month follow-up. Stroke recurrence occurred in 15 (10.1%) and 25 (18.8%) of patients with MAIs administered clopidogrel plus aspirin and placebo plus aspirin, respectively (HR, 0.5; 95% CI, 0.3-0.96; P = .04), 24 (8.9%) and 24 (8.5%) of patients with SAI administered clopidogrel plus aspirin and placebo plus aspirin, respectively (HR, 1.1; 95% CI, 0.6-2.0; P = .71), and 3 (2.6%) and 2 (1.4%) of patients with NAI administered clopidogrel plus aspirin and placebo plus aspirin, respectively (HR, 1.7; 95% CI, 0.3-11.1; P = .56), with P = .04 for treatment × infarction pattern interaction effect. Clopidogrel plus aspirin did not increase moderate to severe bleeding risk. Conclusions and Relevance Infarction patterns can efficiently stratify the risk of recurrent stroke within 3 months of noncardioembolic TIA or minor ischemic stroke. Patients with MAIs received the most pronounced clinical benefit from dual antiplatelet therapy without increasing the risk of moderate to severe bleeding. However, even if after dual antiplatelet treatment, patients with MAIs still had a risk of stroke recurrence as high as those with SAI. Trial Registration clinicaltrials.gov Identifier: NCT00979589.
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Affiliation(s)
- Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - David Wang
- Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria
| | | | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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5
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Sener U, Ocek L, Ilgezdi I, Sahin H, Ozcelik M, Zorlu Y. Significance of Multiple Acute Ischemic Lesions on Initial Diffusion-weighted Imaging in Stroke Patients and Relation of Toast Classification. Ann Indian Acad Neurol 2018; 21:197-202. [PMID: 30258262 PMCID: PMC6137625 DOI: 10.4103/aian.aian_487_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background It is important to know whether or not the stroke risk factors and etiologies of patients with multiple acute infarcts are different to those of patients with a single acute infarct. Aim The frequency of multiple acute infarct was investigated in ischemic stroke patients and a comparison was made of the characteristics of stroke patients with and without multiple acute infarct. Patients and Methods We reviewed the clinical records of 988 ischemic stroke patients who were admitted within 1 week of the onset of stroke and diffusion-weighted imaging (DWI) was performed on first presentation. The clinical characteristics, laboratory, and imaging results were noted from the patient records. According to the DWI findings, the patients were separated into three groups as those with a single acute infarct in a single vascular territory (SI group), those with multiple acute infarcts in a single vascular territory (SMI group) and those with multiple acute infarcts in multiple vascular (MMI group) territories. The frequency of multiple acute infarcts was investigated, and a comparison was made of the characteristics of stroke patients with and without multiple acute infarcts. Results The SMI group included 119 (12%) patients and the MMI group 126 (12.8%). The most common mechanisms of multiple acute infarcts are large artery atherosclerosis and cardiac origin emboli. Moreover, the risk factors most determined were hypertension, diabetes mellitus, and hyperlipidemia in the MMI group. Conclusion No difference was determined between the groups in respect of stroke etiology and risk factors.
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Affiliation(s)
- Ufuk Sener
- Department of Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Levent Ocek
- Department of Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Irem Ilgezdi
- Department of Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hilal Sahin
- Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Murat Ozcelik
- Department of Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yasar Zorlu
- Department of Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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6
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Bumb A, Seifert B, Wetzel S, Agosti R. Patients profiling for Botox® (onabotulinum toxin A) treatment for migraine: a look at white matter lesions in the MRI as a potential marker. SPRINGERPLUS 2013; 2:377. [PMID: 24010035 PMCID: PMC3755787 DOI: 10.1186/2193-1801-2-377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 08/08/2013] [Indexed: 12/18/2022]
Abstract
Background To evaluate if white matter lesions (WML) on MRI can be a potential marker for onabotulinum toxin A (Botox®) treatment success in migraine, given the limited response rate and high costs per treatment. Methods Retrospective data base and MRI analysis of 529 migraineurs who received Botox® between 2002 and 2009. Responders were defined as patients who underwent three or more treatments, whereas non-responders had only one or two treatments. MRIs were analysed on axial T2 and coronar FLAIR (fluid attenuated inversion recovery) sequences for the presence of WML. Statistical analysis was done with the Chi-Square-Test and the Mann–Whitney-U-Test. Results Of 529 Botox® treated migraineurs, 111 patients had a MRI. Of these 111 patients, 47 were responders, 64 non-responders to Botox®. Response rate to Botox® in migraineurs with WML was 55.3%, in migraineurs without WML 44.7%. In the investigated items “age”, “age at onset”, “gender”, “attack duration”, “frequency”, “aura”, “WML”, “size of WML”, we found no statistical significant difference between the two groups. 55% of the responders and 50% of the non-responders showed WML. All WML were located supratentorially, anteriorly, mostly of small size (3–5 mm). Conclusion WML on MRIs cannot serve as a marker to predict a positive response to Botox®.
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Affiliation(s)
- Anja Bumb
- University of Basel, Zürich, Switzerland
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7
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Haines DE, Stewart MT, Barka ND, Kirchhof N, Lentz LR, Reinking NM, Urban JF, Halimi F, Deneke T, Kanal E. Microembolism and Catheter Ablation II. Circ Arrhythm Electrophysiol 2013; 6:23-30. [PMID: 23275248 DOI: 10.1161/circep.112.973461] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David E. Haines
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Mark T. Stewart
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Noah D. Barka
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Nicole Kirchhof
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Linnea R. Lentz
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Nicki M. Reinking
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Jon F. Urban
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Franck Halimi
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Thomas Deneke
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
| | - Emanuel Kanal
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., N.D.B., N.K., L.R.L., N.M.R., J.F.U.); Centre Medico-Chirugical, Le Chesnay, France (F.H.); Heart Center Bad Neustadt, Germany (T.D.); and Department of Radiology, University of Pittsburgh, Pittsburgh, PA (E.K.)
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8
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Gensicke H, Zumbrunn T, Jongen LM, Nederkoorn PJ, Macdonald S, Gaines PA, Lyrer PA, Wetzel SG, van der Lugt A, Mali WPTM, Brown MM, van der Worp HB, Engelter ST, Bonati LH. Characteristics of Ischemic Brain Lesions After Stenting or Endarterectomy for Symptomatic Carotid Artery Stenosis. Stroke 2013; 44:80-6. [DOI: 10.1161/strokeaha.112.673152] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In a substudy of the International Carotid Stenting Study (ICSS), more patients had new ischemic brain lesions on diffusion-weighted magnetic resonance imaging (MRI) after stenting (CAS) than after endarterectomy (CEA). In the present analysis, we compared characteristics of diffusion-weighted MRI lesions.
Methods—
Number, individual and total volumes, and location of new diffusion-weighted MRI lesions were compared in patients with symptomatic carotid stenosis randomized to CAS (n=124) or CEA (n=107) in the ICSS-MRI substudy.
Results—
CAS patients had higher lesion numbers than CEA patients (1 lesion, 15% vs 8%; 2–5 lesions, 19% vs 5%; >5 lesions, 16% vs 4%). The overall risk ratio for the expected lesion count with CAS versus CEA was 8.8 (95% confidence interval, 4.4–17.5;
P
<0.0001) and significantly increased among patients with lower blood pressure at randomization, diabetes mellitus, stroke as the qualifying event, left-side stenosis, and if patients were treated at centers routinely using filter-type protection devices during CAS. Individual lesions were smaller in the CAS group than in the CEA group (
P
<0.0001). Total lesion volume per patient did not differ significantly. Lesions in the CAS group were more likely to occur in cortical areas and subjacent white matter supplied by leptomeningeal arteries than lesions in the CEA group (odds ratio, 4.2; 95% confidence interval, 1.7–10.2;
P
=0.002).
Conclusions—
Compared with patients undergoing CEA, patients treated with CAS had higher numbers of periprocedural ischemic brain lesions, and lesions were smaller and more likely to occur in cortical areas and subjacent white matter. These findings may reflect differences in underlying mechanisms of cerebral ischemia.
Clinical Trial Registration—
URL:
http://www.isrctn.org
. Unique identifier: ISRCTN25337470.
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Affiliation(s)
- Henrik Gensicke
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Thomas Zumbrunn
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Lisa M. Jongen
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Paul J. Nederkoorn
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Sumaira Macdonald
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Peter A. Gaines
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Philippe A. Lyrer
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Stephan G. Wetzel
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Aad van der Lugt
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Willem P. Th. M. Mali
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Martin M. Brown
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - H. Bart van der Worp
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Stefan T. Engelter
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
| | - Leo H. Bonati
- From the Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (H.G., P.A.L., S.T.E., L.H.B.); Clinical Trial Unit, University Hospital Basel, Basel, Switzerland (T.Z.); Department of Radiology (L.M.J., W.P.T.M.M.) and Department of Neurology, Rudolf Magnus Institute of Neuroscience (H.B.v.d.W.), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands (P.J.N.); Department of
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Mustanoja S, Putaala J, Haapaniemi E, Strbian D, Kaste M, Tatlisumak T. Multiple brain infarcts in young adults: clues for etiologic diagnosis and prognostic impact. Eur J Neurol 2012; 20:216-22. [DOI: 10.1111/j.1468-1331.2012.03872.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- S. Mustanoja
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - J. Putaala
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - E. Haapaniemi
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - D. Strbian
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - M. Kaste
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
| | - T. Tatlisumak
- Department of Neurology; Helsinki University Central Hospital; Helsinki; Finland
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Chen SF, Lu CH, Lui CC, Huang CR, Chuang YC, Tan TY, Tsai NW, Chang CC, Tsai WC, Chang WN. Acute/subacute cerebral infarction (ASCI) in HIV-negative adults with cryptococcal meningoencephalitis (CM): a MRI-based follow-up study and a clinical comparison to HIV-negative CM adults without ASCI. BMC Neurol 2011; 11:12. [PMID: 21269442 PMCID: PMC3037868 DOI: 10.1186/1471-2377-11-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 01/26/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute/subacute cerebral infarction (ASCI) in HIV-negative cryptococcal meningoencephalitis (CM) adults has rarely been examined by a series of MRI-based follow-up study. We studied a series of MRI follow-up study of CM adults and compared the clinical characters of those with ASCI and those without ASCI. METHODS The clinical characteristics and a series of brain MRI findings of seven CM adults with ASCI were enrolled for analysis. The clinical characteristics of another 30 HIV-negative CM adults who did not have ASCI were also included for a comparative analysis. RESULTS The seven HIV-negative CM adults with ASCI were four men and three women, aged 46-78 years. Lacunar infarction was the type of ASCI, and 86% (6/7) of the ACSI were multiple infarctions distributed in both the anterior and posterior cerebrovascular territories. The seven CM patients with ASCI were significantly older and had a higher rate of DM and previous stroke than the other 30 CM adults without ASCI. They also had a higher incidence of consciousness disturbance at presentation and had a poor prognosis. CONCLUSION ASCI was found in 18.9% (7/37) of HIV-negative CM adults. Serial MRI follow-up studies may allow a better delineation of ASCI in this specific group of infectious disease and multiple lacunar infarctions was the most common type. Older in age and presence of DM and previous stroke were the significant underlying conditions. CM patients with ASCI also had a poor therapeutic outcome.
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Affiliation(s)
- Shu-Fang Chen
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Chun-Chung Lui
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Chi-Ren Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Yao-Chung Chuang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Teng-Yeow Tan
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Wan-Chen Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niaosung, Kaohsiung 833, Taiwan
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11
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Purroy F, Begué R, Gil MI, Quílez A, Sanahuja J, Brieva L, Piñol-Ripoll G. Patterns of diffusion-weighted magnetic resonance imaging associated with etiology improve the accuracy of prognosis after transient ischaemic attack. Eur J Neurol 2010; 18:121-8. [DOI: 10.1111/j.1468-1331.2010.03080.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Bonati LH, Wetzel SG, Kessel-Schaefer A, Buser P, Lyrer PA, Engelter ST. Diffusion-weighted imaging findings differ between stroke attributable to spontaneous cervical artery dissection and patent foramen ovale. Eur J Neurol 2009; 17:307-13. [DOI: 10.1111/j.1468-1331.2009.02805.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Bonati LH, Wetzel SG, Gandjour J, Baumgartner RW, Lyrer PA, Engelter ST. Diffusion-Weighted Imaging in Stroke Attributable to Internal Carotid Artery Dissection. Stroke 2008; 39:483-5. [DOI: 10.1161/strokeaha.107.496760] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background and Purpose—
In stroke attributable to spontaneous dissection of the internal carotid artery (sICAD), arterial patency may influence the pattern and extent of cerebral ischemia.
Methods—
In 40 consecutive patients with stroke caused by sICAD, we compared the number, size and pattern of cerebral diffusion-weighted imaging lesions between patients with stenotic sICAD (n=15) and occlusive sICAD (n=25).
Results—
Patients with stenotic sICAD had more ischemic lesions (median 5, interquartile range 1 to 10) than patients with occlusive sICAD (2, 1 to 3;
P
=0.014). Lesion diameters were larger in occlusive sICAD (62, 50 to 99 mm) than in stenotic sICAD (25, 10 to 50 mm;
P
=0.007). Border-zone infarction occurred only in stenotic sICAD (7/15, 47%). Most patients with occlusive sICAD had territorial infarcts (22/25, 88%).
Conclusions—
In stroke attributable to sICAD, diffusion-weighted imaging characteristics may be influenced by the patency of the carotid artery. Differences in the pathogenesis of cerebral ischemia might exist between patients with stenotic and those with occlusive sICAD.
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Affiliation(s)
- Leo H. Bonati
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
| | - Stephan G. Wetzel
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
| | - Joubin Gandjour
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
| | - Ralf W. Baumgartner
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
| | - Philippe A. Lyrer
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
| | - Stefan T. Engelter
- From the Department of Neurology and Stroke Unit (L.H.B., P.A.L., S.T.E.) and Department of Radiology (S.G.W.), University Hospital Basel, and Department of Neurology and Stroke Unit (J.G., R.W.B.), University Hospital Zürich, Switzerland
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Axer H, Grässel D, Brämer D, Fitzek S, Kaiser WA, Witte OW, Fitzek C. Time course of diffusion imaging in acute brainstem infarcts. J Magn Reson Imaging 2008; 26:905-12. [PMID: 17896361 DOI: 10.1002/jmri.21088] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To study the time course of diffusion imaging at the lesion site in brainstem infarcts. MATERIALS AND METHODS Sequential MR scans were acquired from 24 patients with brainstem infarcts. Diffusion-weighted images (DWI), T(2)-weighted images (T(2)w), maps of apparent diffusion coefficient, and maps of fractional anisotropy were generated from each MR scan. A trend function was fitted to these measurements to model an objective, general time course of the studied parameters. RESULTS Apparent diffusion coefficient (ADC) continuously decreased over time until a transition time around 45 hours; afterwards a continuous increase took place. After the 14th day ADC reached values similar to the ADC of the intact contralateral side (pseudonormalization) and then further increased. Fractional anisotropy (FA) decreased continuously over 3 to 6 months. CONCLUSION Times of transition and pseudonormalization of ADC were longer than described for territorial hemispheric infarcts and describe the acute to subacute phase of brainstem ischemia. In contrast, the continuous decline of FA over 3 to 6 months indicates a chronic process of change of histological structures in brainstem ischemia, and may be regarded as an indicator of the chronic phase.
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Affiliation(s)
- Hubertus Axer
- Department of Neurology, Friedrich-Schiller-University Jena, Jena, Germany.
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15
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Cho AH, Kim JS, Jeon SB, Kwon SU, Lee DH, Kang DW. Mechanism of multiple infarcts in multiple cerebral circulations on diffusion-weighted imaging. J Neurol 2007; 254:924-30. [PMID: 17401747 DOI: 10.1007/s00415-006-0397-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 12/05/2005] [Accepted: 01/09/2006] [Indexed: 10/23/2022]
Abstract
Acute multiple infarcts in multiple cerebral circulations (AMIMC) are thought to suggest the presence of cardioembolic sources or systemic hypercoagulopathy. However, the mechanism and the simultaneous occurrence of AMIMC are not well known. We reviewed 685 consecutive acute ischemic stroke patients who underwent diffusion-weighted imaging (DWI) within 48 hours of onset. AMIMC was defined as multiple acute DWI lesions distributed in more than one cerebral circulation (i.e., 2 anterior and 1 posterior circulations). Signal intensities on apparent diffusion coefficient (ADC) maps corresponding to acute DWI lesions were classified as 'low', 'iso-' or 'high' signals. Blood markers obtained within 24 hours after admission were compared between patients with and without AMIMC. Sixty-seven (9.8%) patients had AMIMC. Frequency of cardioembolism in AMIMC patients was only 29.9% (20/67), which was not different from non-AMIMC patients (21.7%, p = 0.16). Large-artery atherosclerosis (LAA) or small-vessel occlusion (SVO) in multiple circulations or combined LAA and SVO were identified in 34.3% (23/ 67) of AMIMC patients, although pure LAA and pure SVO were less frequent than in non-AMIMC patients. ADC signals were purely 'low' in 38 (56.7%) and 'mixed' (low with iso- or high) in 29 (43.3%). Cardioembolism tended to be associated with 'low' ADC signals (75.0%) compared with other stroke mechanisms (48.9%; p = 0.062). C-reactive protein was higher in AMIMC than in non- AMIMC patients (p = 0.009). Stroke mechanisms responsible for AMIMC are heterogeneous. ADC findings suggest that AMIMC commonly occur stepwise and may be useful in determining stroke mechanism. Systemic inflammation may be associated with the pathogenesis of AMIMC.
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Affiliation(s)
- A-Hyun Cho
- Department of Neurology, Asan Medical Center University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, Seoul 138-736, Korea
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Schulz UGR, Flossmann E, Francis JM, Redgrave JN, Rothwell PM. Evolution of the diffusion-weighted signal and the apparent diffusion coefficient in the late phase after minor stroke: a follow-up study. J Neurol 2007; 254:375-83. [PMID: 17345037 DOI: 10.1007/s00415-006-0381-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Accepted: 05/24/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Diffusion-weighted imaging (DWI) is mainly used in acute stroke, and signal evolution in the acute phase has been studied extensively. However, patients with a minor stroke frequently present late. Recent studies suggest that DWI may be helpful at this stage, but only very few published data exist on the evolution of the DW-signal in the weeks and months after a stroke. We performed a follow-up study of DWI in the late stages after a minor stroke. METHODS 28 patients who presented 48 hours to 14 days after a minor stroke underwent serial MRI at baseline, 4 weeks, 8 weeks, 12 weeks, 6 months and>or=9 months after their event. Signal intensity within the lesion was determined on T2-weighted images, DW-images and the Apparent Diffusion Coefficient (ADC) map at each time-point, and ratios were calculated with contralateral normal values (T2r, DWIr, ADCr). RESULTS T2r was increased in all patients from the beginning, and showed no clear temporal evolution. ADCr normalized within 8 weeks in 83% of patients, but still continued to increase for up to 6 months after the event. The DW-signal decreased over time, but was still elevated in 6 patients after>or=6 months. The evolution of ADCr and DWIr showed statistically highly significant inter-individual variation (p<0.0001), which was not accounted for by age, sex, infarct size or infarct location. CONCLUSION The ADC and the DW-signal may continue to evolve for several months after a minor ischaemic stroke. Signal evolution is highly variable between individuals. Further studies are required to determine which factors influence the evolution of the ADC and the DW-signal.
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Affiliation(s)
- U G R Schulz
- Department of Clinical Stroke Prevention Research Unit, University of Neurology, Radcliffe Infirmary, and Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, OX2 6HE, United Kingdom
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Andreone N, Tansella M, Cerini R, Rambaldelli G, Versace A, Marrella G, Perlini C, Dusi N, Pelizza L, Balestrieri M, Barbui C, Nosè M, Gasparini A, Brambilla P. Cerebral atrophy and white matter disruption in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 2007; 257:3-11. [PMID: 16960652 DOI: 10.1007/s00406-006-0675-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2005] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Abstract
Several magnetic resonance imaging (MRI) studies have shown cerebral atrophy in established schizophrenia, although not in all reports. Discrepancies may mostly be due to population and postprocessing differences. Recently, disruption of cortical white matter integrity has also been reported in chronic patients with schizophrenia. In this study we explored tridimensional (3D) cerebral volumes and white matter microstructure in schizophrenia with structural and diffusion magnetic resonance. Twenty-five patients with established schizophrenia and 25 1:1 matched normal controls underwent a session of MRI using a Siemens 1.5T-scanner. 3D brain volume reconstruction was performed with the semi-automatic software Amira (TGS, San Diego, CA), whereas the apparent diffusion coefficients (ADCs) of cortical white matter water molecules were obtained with in-house developed softwares written in MatLab (The Mathworks-Inc., Natick, MA). Compared to controls, patients with schizophrenia had significantly smaller gray matter intracranium and total brain volumes, increased 4th ventricle volumes, and greater temporal and occipital ADCs. Patients treated with typical antipsychotic medication (N = 9) had significantly larger right lateral and 4th ventricles compared to those on atypical antipsychotic drugs. Intracranial volumes significantly inversely correlated with left temporal ADC in patients with schizophrenia. Also, age correlated directly with right, left, and 3rd ventricle volumes and inversely with gray matter intracranium volumes in individuals with schizophrenia. This study confirmed the presence of cortical atrophy in patients with schizophrenia, especially in those on typical antipsychotic drugs, and the existence of white matter disruption. It also suggested that physiological aging effects on brain anatomy may be abnormally pronounced in schizophrenia.
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Affiliation(s)
- Nicola Andreone
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
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18
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Bonati LH, Kessel-Schaefer A, Linka AZ, Buser P, Wetzel SG, Radue EW, Lyrer PA, Engelter ST. Diffusion-Weighted Imaging in Stroke Attributable to Patent Foramen Ovale. Stroke 2006; 37:2030-4. [PMID: 16809562 DOI: 10.1161/01.str.0000231655.52686.ab] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Patent foramen ovale (PFO) is an established cause of stroke in young patients without other determined etiologies (ie, cryptogenic stroke). The additional presence of atrial septum aneurysm (ASA) possibly increases stroke risk, but it remains undetermined which factors best predict thromboembolism in patients with PFO. Diffusion-weighted imaging (DWI) may help to distinguish the characteristics of cerebral embolism associated with different features of the interatrial septum in PFO stroke. METHODS In a stroke databank-based cohort study, DWI and transthoracic/transesophageal echocardiography findings were assessed in 48 consecutive patients with cryptogenic ischemic stroke associated with PFO. The number, size, and distribution of acute ischemic lesions on DWI were correlated with PFO size, degree of interatrial right-to-left shunt (RLS), and the presence of ASA. RESULTS Patients with PFO plus ASA combined more often had multiple acute DWI lesions (16 of 30, 53%) than those with PFO alone (3 of 18, 17%; P=0.01). This association remained significant after correction for PFO size, degree of RLS, and vascular risk factors in a logistic-regression analysis (P=0.04). No significant associations between DWI lesion characteristics and PFO size or degree of RLS were found. CONCLUSIONS The presence of concomitant ASA is independently associated with multiple cerebral ischemic lesions in PFO stroke, which may indicate an increased embolic risk.
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Affiliation(s)
- Leo H Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
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