Differences in diffusion-weighted image and transesophageal echocardiographical findings in cardiogenic, paradoxical and aortogenic brain embolism

Shigeru Fujimoto, Kazunori Toyoda, Juro Jinnouchi, Masahiro Yasaka, Takanari Kitazono, Yasushi Okada

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background and Purpose: The purpose of the present study was to clarify the difference in the infarct topography on diffusion-weighted image (DWI) and cardiac and aortic findings on transesophageal echocardiography (TEE) in stroke patients with different embolic sources. Methods: We studied 270 consecutive patients with acute ischemic stroke who had DWI-documented cortical or subcortical infarcts without significant stenosis of the cerebral arteries. As embolic sources, cardiac diseases, right-to-left shunt diseases and an aortic arch atheroma ≥4.0 mm in thickness were identified using various diagnostic tools including TEE. Results: Seventy-eight (29%) patients had multiple embolic sources. Large infarcts were common in patients in whom cardiac disease was the only embolic source and uncommon in patients in whom aortic atheroma was the only embolic source (p < 0.0001). Vertebrobasilar infarcts were relatively common in patients only having aortic atheromas. Atrial septal aneurysms were more common in patients with a right-to-left shunt than in those with a shunt plus other embolic sources (p = 0.0036). Unique characteristics of the arch atheroma (mobile plaque, extension to branches, or ulcer formation; p < 0.0001) as well as small or moderate-sized infarcts (p = 0.0004) were more common in patients with arch atheromas as the only embolic source than in those with atheromas plus other embolic sources. Conclusions: Embolic stroke patients often have multiple embolic sources. The present study suggests the possibility that embolic stroke has unique clinical features depending on its source. DWI and TEE findings might be helpful in characterizing cardiogenic, paradoxical and aortogenic brain embolism.

Original languageEnglish
Pages (from-to)148-154
Number of pages7
JournalCerebrovascular Diseases
Volume32
Issue number2
DOIs
Publication statusPublished - Aug 1 2011

Fingerprint

Intracranial Embolism
Atherosclerotic Plaques
Transesophageal Echocardiography
Stroke
Heart Diseases
Cerebral Arteries
Thoracic Aorta
Ulcer
Aneurysm
Pathologic Constriction

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Differences in diffusion-weighted image and transesophageal echocardiographical findings in cardiogenic, paradoxical and aortogenic brain embolism. / Fujimoto, Shigeru; Toyoda, Kazunori; Jinnouchi, Juro; Yasaka, Masahiro; Kitazono, Takanari; Okada, Yasushi.

In: Cerebrovascular Diseases, Vol. 32, No. 2, 01.08.2011, p. 148-154.

Research output: Contribution to journalArticle

Fujimoto, Shigeru ; Toyoda, Kazunori ; Jinnouchi, Juro ; Yasaka, Masahiro ; Kitazono, Takanari ; Okada, Yasushi. / Differences in diffusion-weighted image and transesophageal echocardiographical findings in cardiogenic, paradoxical and aortogenic brain embolism. In: Cerebrovascular Diseases. 2011 ; Vol. 32, No. 2. pp. 148-154.
@article{edff8263e99642f78642946b11a3351a,
title = "Differences in diffusion-weighted image and transesophageal echocardiographical findings in cardiogenic, paradoxical and aortogenic brain embolism",
abstract = "Background and Purpose: The purpose of the present study was to clarify the difference in the infarct topography on diffusion-weighted image (DWI) and cardiac and aortic findings on transesophageal echocardiography (TEE) in stroke patients with different embolic sources. Methods: We studied 270 consecutive patients with acute ischemic stroke who had DWI-documented cortical or subcortical infarcts without significant stenosis of the cerebral arteries. As embolic sources, cardiac diseases, right-to-left shunt diseases and an aortic arch atheroma ≥4.0 mm in thickness were identified using various diagnostic tools including TEE. Results: Seventy-eight (29{\%}) patients had multiple embolic sources. Large infarcts were common in patients in whom cardiac disease was the only embolic source and uncommon in patients in whom aortic atheroma was the only embolic source (p < 0.0001). Vertebrobasilar infarcts were relatively common in patients only having aortic atheromas. Atrial septal aneurysms were more common in patients with a right-to-left shunt than in those with a shunt plus other embolic sources (p = 0.0036). Unique characteristics of the arch atheroma (mobile plaque, extension to branches, or ulcer formation; p < 0.0001) as well as small or moderate-sized infarcts (p = 0.0004) were more common in patients with arch atheromas as the only embolic source than in those with atheromas plus other embolic sources. Conclusions: Embolic stroke patients often have multiple embolic sources. The present study suggests the possibility that embolic stroke has unique clinical features depending on its source. DWI and TEE findings might be helpful in characterizing cardiogenic, paradoxical and aortogenic brain embolism.",
author = "Shigeru Fujimoto and Kazunori Toyoda and Juro Jinnouchi and Masahiro Yasaka and Takanari Kitazono and Yasushi Okada",
year = "2011",
month = "8",
day = "1",
doi = "10.1159/000328652",
language = "English",
volume = "32",
pages = "148--154",
journal = "Cerebrovascular Diseases",
issn = "1015-9770",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Differences in diffusion-weighted image and transesophageal echocardiographical findings in cardiogenic, paradoxical and aortogenic brain embolism

AU - Fujimoto, Shigeru

AU - Toyoda, Kazunori

AU - Jinnouchi, Juro

AU - Yasaka, Masahiro

AU - Kitazono, Takanari

AU - Okada, Yasushi

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Background and Purpose: The purpose of the present study was to clarify the difference in the infarct topography on diffusion-weighted image (DWI) and cardiac and aortic findings on transesophageal echocardiography (TEE) in stroke patients with different embolic sources. Methods: We studied 270 consecutive patients with acute ischemic stroke who had DWI-documented cortical or subcortical infarcts without significant stenosis of the cerebral arteries. As embolic sources, cardiac diseases, right-to-left shunt diseases and an aortic arch atheroma ≥4.0 mm in thickness were identified using various diagnostic tools including TEE. Results: Seventy-eight (29%) patients had multiple embolic sources. Large infarcts were common in patients in whom cardiac disease was the only embolic source and uncommon in patients in whom aortic atheroma was the only embolic source (p < 0.0001). Vertebrobasilar infarcts were relatively common in patients only having aortic atheromas. Atrial septal aneurysms were more common in patients with a right-to-left shunt than in those with a shunt plus other embolic sources (p = 0.0036). Unique characteristics of the arch atheroma (mobile plaque, extension to branches, or ulcer formation; p < 0.0001) as well as small or moderate-sized infarcts (p = 0.0004) were more common in patients with arch atheromas as the only embolic source than in those with atheromas plus other embolic sources. Conclusions: Embolic stroke patients often have multiple embolic sources. The present study suggests the possibility that embolic stroke has unique clinical features depending on its source. DWI and TEE findings might be helpful in characterizing cardiogenic, paradoxical and aortogenic brain embolism.

AB - Background and Purpose: The purpose of the present study was to clarify the difference in the infarct topography on diffusion-weighted image (DWI) and cardiac and aortic findings on transesophageal echocardiography (TEE) in stroke patients with different embolic sources. Methods: We studied 270 consecutive patients with acute ischemic stroke who had DWI-documented cortical or subcortical infarcts without significant stenosis of the cerebral arteries. As embolic sources, cardiac diseases, right-to-left shunt diseases and an aortic arch atheroma ≥4.0 mm in thickness were identified using various diagnostic tools including TEE. Results: Seventy-eight (29%) patients had multiple embolic sources. Large infarcts were common in patients in whom cardiac disease was the only embolic source and uncommon in patients in whom aortic atheroma was the only embolic source (p < 0.0001). Vertebrobasilar infarcts were relatively common in patients only having aortic atheromas. Atrial septal aneurysms were more common in patients with a right-to-left shunt than in those with a shunt plus other embolic sources (p = 0.0036). Unique characteristics of the arch atheroma (mobile plaque, extension to branches, or ulcer formation; p < 0.0001) as well as small or moderate-sized infarcts (p = 0.0004) were more common in patients with arch atheromas as the only embolic source than in those with atheromas plus other embolic sources. Conclusions: Embolic stroke patients often have multiple embolic sources. The present study suggests the possibility that embolic stroke has unique clinical features depending on its source. DWI and TEE findings might be helpful in characterizing cardiogenic, paradoxical and aortogenic brain embolism.

UR - http://www.scopus.com/inward/record.url?scp=79960486318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960486318&partnerID=8YFLogxK

U2 - 10.1159/000328652

DO - 10.1159/000328652

M3 - Article

C2 - 21778712

AN - SCOPUS:79960486318

VL - 32

SP - 148

EP - 154

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

SN - 1015-9770

IS - 2

ER -