Small obliquely oriented cortical cerebellar infarctions are associated with cardioembolic stroke

BMC Neurology

Vincent Thijs¹  Adrien Ter Schiphorst²  Dimitri Renard²  Lavinia Tatu²  Eric Thouvenot³  Christophe Demattei⁴ 

[1] 0000 0001 2179 088X, grid.1008.9, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic, Australia;grid.410678.c, Department of Neurology, Austin Health, Heidelberg, Vic, Australia;0000 0004 0593 8241, grid.411165.6, Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France;0000 0004 0593 8241, grid.411165.6, Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France;0000 0001 2097 0141, grid.121334.6, Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Université Montpellier, Montpellier, France;0000 0004 0593 8241, grid.411165.6, Service de Biostatistique, Epidémiologie Clinique, Santé Publique et Innovation en Méthodologie (BESPIM), Nîmes University Hospital, Nîmes, France;

关键词: Stroke;    Infarction;    Obliquely;    Cerebellar;    Cortical;    Cardioembolic;    Cardioembolism;   

DOI  :  10.1186/s12883-019-1328-0

来源: publisher

【 摘 要 】

BackgroundA revised classification of cerebellar infarctions (CI) may uncover unrecognized associations with etiologic stroke subtypes. We hypothesized that obliquely oriented small cortical cerebellar infarction (SCCI) representing end zone infarctions on MRI would be associated with cardiac embolism.MethodsWe retrospectively analyzed consecutive stroke patients recruited between January–December 2016 in our center. Analyzed baseline characteristics: sex, age, cardiovascular risk factors, history of stroke or atrial fibrillation (AF). TOAST classification was used for determining stroke subtype. Acute infarction location (anterior/posterior/mixed anterior-posterior circulation), acute uni- or multiterritorial infarction, and acute or chronic CI/SCCI/non-SCCI were assessed by MRI, and vertebrobasilar stenosis/occlusion by vessel imaging. Pre-specified analysis was also performed in patients without known high cardioembolic risk (known AF history or acute multiterritorial infarction).ResultsWe included 452 patients (CI in 154, isolated SCCI in 55, isolated non-SCCI in 50, and mixed SCCI/non-SCCI in 49). Both SCCI and non-SCCI were associated with AF history (SCCI, p = 0.021; non-SCCI, p = 0.004), additional acute posterior circulation infarction (p < 0.001 both CI-subtypes), multiterritorial infarctions (SCCI, p = 0.003; non-SCCI, p < 0.001) and cardioembolic more frequent than large-artery atherosclerosis origin (p < 0.001 for both CI-subtypes). SCCI was associated with older age (p < 0.001), whereas non-SCCI was associated with stroke history (p = 0.036) and vertebrobasilar stenosis/occlusion (p = 0.002). SCCI were older (p = 0.046) than non-SCCI patients, had less frequently prior stroke (p < 0.001), and more frequent cardioembolic infarction (p = 0.025).In patients without known high cardioembolic risk (n = 348), SCCI was strongly associated with subsequent cardioembolism diagnosis (OR 3.00 [CI 1.58–5.73, p < 0.001]). No such association was present in non-SCCI.ConclusionsAcute or chronic SCCI are strongly associated with a cardioembolic origin.

【 授权许可】

CC BY