Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2001
Spotty cortical enhancement detected by magnetic resonance imaging: a sign of embolic transient ischemic attack and stroke?
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Wada K, Kimura K, Minematsu K, Uchino M, Yamaguchi T
Аннотация
OBJECTIVE: Patients with transient ischemic attack (TIA) or minor stroke occasionally have spotty cortical lesions that are visualized with contrast-enhanced magnetic resonance imaging studies. We attempted to clarify the clinical characteristics of patients with these findings by giving them the name spotty cortical enhancement (SCE).
METHODS: Out of 746 consecutive patients with acute ischemic stroke or TIA, 29 patients had the SCE in the region of the middle cerebral artery. We defined the SCE as a cortical lesion less than 1.5 cm in diameter, as visualized by contrast-enhanced magnetic resonance imaging within 30 days of symptom onset. Neurologic symptoms and signs, potential cardiac sources of emboli, or arterial disease were evaluated in all patients with SCE.
RESULTS: The patients always had an abrupt onset of symptoms. Cortical signs without hemiparesis were observed in 4 patients, cortical signs with hemiparesis in 6, monoparesis in 11, and mild to moderate hemiparesis alone in the remaining 8 patients. The deficits were fully recovered within the first 24 hours in 13 patients and within 30 days in the other patients. Significant cerebral arterial lesions (> or =50% stenosis in diameter) and potential cardiac sources of emboli were found in 21 and 7 patients, respectively. In only 3 patients (10.3%), neither cardiac sources nor arterial stenosis could be detected.
CONCLUSION: The present results suggest that the SCE indicates small cortical infarcts caused by cardiogenic or artery-to-artery embolism. Patients with the SCE should be distinguished clinically from those with lacunar stroke or with hemodynamic TIA or stroke.
METHODS: Out of 746 consecutive patients with acute ischemic stroke or TIA, 29 patients had the SCE in the region of the middle cerebral artery. We defined the SCE as a cortical lesion less than 1.5 cm in diameter, as visualized by contrast-enhanced magnetic resonance imaging within 30 days of symptom onset. Neurologic symptoms and signs, potential cardiac sources of emboli, or arterial disease were evaluated in all patients with SCE.
RESULTS: The patients always had an abrupt onset of symptoms. Cortical signs without hemiparesis were observed in 4 patients, cortical signs with hemiparesis in 6, monoparesis in 11, and mild to moderate hemiparesis alone in the remaining 8 patients. The deficits were fully recovered within the first 24 hours in 13 patients and within 30 days in the other patients. Significant cerebral arterial lesions (> or =50% stenosis in diameter) and potential cardiac sources of emboli were found in 21 and 7 patients, respectively. In only 3 patients (10.3%), neither cardiac sources nor arterial stenosis could be detected.
CONCLUSION: The present results suggest that the SCE indicates small cortical infarcts caused by cardiogenic or artery-to-artery embolism. Patients with the SCE should be distinguished clinically from those with lacunar stroke or with hemodynamic TIA or stroke.