Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories.

Background and Purpose- Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory. Methods- We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier. Results- A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1-7] versus 1 [0-4]) and modified Rankin Scale (3 [1-4] versus 2 [1-3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI. Conclusions- In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.

Clinical Importance of Temporal Bone Features for the Efficacy of Contrast-Enhanced Sonothrombolysis: a Retrospective Analysis of the NOR-SASS Trial.

Contrast-enhanced sonothrombolysis (CEST) seems to be a safe and promising treatment in acute ischemic stroke. It remains unknown if temporal bone features may influence the efficacy of CEST. We investigated the association between different temporal bone features on admission computed tomography (CT) scan and the outcome in acute ischemic stroke patients included in the randomized Norwegian Sonothrombolysis in Acute Stroke Study (NOR-SASS). Patients diagnosed as stroke mimics and those with infratentorial stroke or with incorrect insonation were excluded. We retrospectively assessed temporal bone heterogeneity (presence of diploë), diploë ratio, thickness, and density on admission CT scans. National institute of Health Stroke Scale (NIHSS) at 24 h and modified Rankin Scale (mRS) at 3 months were correlated with CT findings both in CEST and sham CEST patients. A total of 99 patients were included of which 52 were assigned to CEST and 47 to sham CEST. Approximately 20% patients had a heterogeneous temporal bone in both the CEST and sham CEST group. All temporal bone CT features studied were associated with female sex. In the CEST group, temporal bone heterogeneity (p = 0.006) and higher temporal bone diploë ratio (p = 0.002) were associated with higher NIHSS at 24 h. There was no association between temporal bone features and mRS at 3 months. Approximately 20% of acute ischemic stroke patients have heterogeneous temporal bone and may be resistant to standard 2-MHz transcranial Doppler ultrasound treatment. Sonothrombolysis resistance may easily be predicted by admission CT for better selection.

Time patterns in multiple acute cerebral infarcts.

Background Multiple acute cerebral infarcts in different arterial territories may be caused by several emboli concurrently or successively. Aim and/or hypothesis We hypothesized that the time from stroke onset to magnetic resonance imaging may shed light on underlying mechanisms of multiple acute cerebral infarcts. Methods This is a prospective observational cohort study involving 2697 ischemic stroke patients conducted at Haukeland University Hospital between February 2006 and October 2013. Only patients with diffusion-weighted imaging lesions in more than one arterial territory (left or right anterior circulation or posterior circulation) were included. The time from stroke onset to magnetic resonance imaging was registered and correlated with the etiology of multiple acute cerebral infarcts in each patient. Results We reviewed 2697 consecutive patients and 2220 (82%) underwent magnetic resonance imaging. Among these 2125 (96%) had diffusion-weighted imaging lesions. We found 187 multiple acute cerebral infarct patients who were then included in the study. There was positive correlation (0.20; p < .001) between time to magnetic resonance imaging and frequency of multiple acute cerebral infarcts caused by internal carotid stenosis. There was no correlation (-.02) between time to magnetic resonance imaging and frequency of multiple acute cerebral infarcts caused by cardiogenic embolism. Conclusions Multiple acute cerebral infarcts associated with cardiogenic embolism seem to happen concurrently as a shower of emboli whereas multiple acute cerebral infarcts associated with internal carotid artery stenosis seem to occur successively separated by hours or days.