Background
Multidetector computed tomography angiography (MDCTA) is useful to inspect cardiovascular
pathologic changes with minimal invasiveness. Here we evaluated the usefulness of
MDCTA to determine the cause of acute multiple brain infarction (AMBI).
Methods
AMBI was defined as multiple recent infarcts demonstrated on diffusion-weighted imaging.
A new infarction within 2 weeks from the last was also considered an AMBI.
Results
Between January 2012 and December 2013, 967 patients were diagnosed with acute brain
infarction and 138 (14.3%) with AMBI. Among them, 57 (39 men and 18 women; age, 38-93
years) were examined by MDCTA using the dual-phase method. All images were diagnostic,
even if patients found it difficult to hold their breath. Fifteen patients (26.3%)
were diagnosed with patent foramen ovale (PFO). Two had complications of atrial fibrillation
(AF), necessitating anticoagulant therapy (ACT). Four had both PFO and severe aortic
atherosclerotic plaque formation, necessitating single antiplatelet therapy (APT)
and/or ACT. Fifteen patients (26.3%) developed complicated arterial plaques around
the aortic arch and were administered single or dual APT and/or ACT, except 1 patient
with a history of multiple cerebral bleeding. Nine patients had pre-existing AF. Furthermore,
ACT was initiated for 2 other patients with thrombus or circulatory stasis in the
left atrial appendage despite normal electrocardiographic findings. Two other patients
were diagnosed with advanced cancer, which was considered Trousseau syndrome. The
cause of AMBI was determined in 36 (63.2%) patients.
Conclusions
MDCTA is a useful and less invasive method to identify the cause of embolic infarction.
Key Words
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Article info
Publication history
Published online: October 07, 2014
Accepted:
August 27,
2014
Received in revised form:
August 24,
2014
Received:
July 10,
2014
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.08.032
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
