Multiple brain infarcts in young adults: clues for etiologic diagnosis and prognostic impact. Issue 2 (11th October 2012)

• Record Type: Journal Article
• Authors: Mustanoja, S.; Putaala, J.; Haapaniemi, E.; Strbian, D.; Kaste, M.; Tatlisumak, T.
• Is Part Of: European journal of neurology. Volume 20:Issue 2(2013:Feb.)
• Page Start: 216
• Page End: 222
• Publication Date: 2012-10-11
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/j.1468-1331.2012.03872.x
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" id="ene3872-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene3872-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>There are little data on the etiology of multiple brain infarcts (MBI) and their impact on clinical outcome in young patients.</p> </sec> <sec id="ene3872-sec-0002" sec-type="section"> <title>Methods</title> <p>We studied 548 MRI‐imaged patients (15–49 years) with a first‐ever ischaemic stroke. Ischaemic lesions were categorized into three groups: single lesions, MBI in one or >1 circulation territories. Outcomes were unfavorable 3‐month modified Rankin Scale (mRS) score of ≥2 and, during long‐term follow‐up (mean 8.20 ± 4.01 years), recurrent ischaemic stroke or death from any cause.</p> </sec> <sec id="ene3872-sec-0003" sec-type="section"> <title>Results</title> <p>Multiple brain infarcts occurred in 185 patients (33.8%; mean age 39.2 ± 8.2), of which 144 patients (26.3%) had lesions located in a single territory and 41 patients (7.5%) in multiple territories. Patients with MBI in a single territory were more likely than patients with single lesions to have a high‐risk source of cardioembolism (CE) (9.0% vs. 3.0%; <italic>P </italic>=<italic> </italic>0.001), large‐artery atherosclerosis (8.3% vs. 4.9%; <italic>P </italic>=<italic> </italic>0.012), vertebral (22% vs. 10%; <italic>P </italic><<italic> </italic>0.001) or carotid artery dissections (8.3% vs. 6.3%; <italic>P </italic>=<italic> </italic>0.036), and MBI in multiple territories a high‐risk source of CE (34% vs. 3.0%, <italic>P </italic><<italic> </italic>0.001). Adjusted for age, gender, baseline stroke severity, size of the largest lesion, and stroke subtype, MBI remained independently associated with an unfavorable 3‐month outcome (odds ratio 2.84, 95% confidence interval 1.22–6.61). In multivariate Cox proportional hazards analysis, MBI had independent influence on the risk for death (hazard ratio 3.75, 1.58–8.86), but not on recurrent ischaemic stroke.</p> </sec> <sec id="ene3872-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Compared with the elderly, young stroke patients have a distinct stroke etiology underlying MBI, being an independent indicator of poor short‐term outcome and long‐term risk of death.</p> </sec> </abstract>