J Clin Neurol.  2005 Apr;1(1):50-58. 10.3988/jcn.2005.1.1.50.

Non-cardioembolic Mechanisms in Cryptogenic Stroke: Clinical and Diffusion-weighted Imaging Features

• Bang OY
• Lee PH
• Yeo SH
• Kim JW
• Joo IS
• Huh K

• KMID: 2287713
• DOI: http://doi.org/10.3988/jcn.2005.1.1.50

Abstract

BACKGROUND
The role of several cardiogenic risk factors, including patent foramen ovale, in patients with cryptogenic stroke has been extensively studied. However, little attention has been paid to the role of non-cardioembolic causes of cryptogenic stroke. We therefore sought to identify the characteristics of cryptogenic stroke.
METHODS
We studied 832 patients with acute infarction in the middle cerebral arterial territory. We divided the patients into four subtypes: 402 with large artery atherosclerosis (LAA), 133 with cardioembolism, 182 with small arterial occlusion (SAO), and 115 with cryptogenic stroke. We compared risk factors and lesion patterns observed by diffusion-weighted imaging (DWI) between patients with cryptogenic stroke and those with stroke of other subtypes.
RESULTS
Both risk factors and DWI lesion patterns differed between the cryptogenic and cardioembolic groups (P<0.05). Risk factors for cryptogenic stroke were similar to those for the LAA and SAO groups. Similarly, DWI lesion patterns for cryptogenic stroke were similar to LAA patients. Large cortical infarcts on DWI were more common in the cardioembolic group than in the LAA or cryptogenic groups (P<0.001). In contrast, deep, non-lacunar (OR 5.02; 95% CI 2.68~9.40; P<0.001) and superficial perforator infarcts (OR 2.23; 95% CI 1.08~4.59; P=0.029) were independently associated with the cryptogenic group.
CONCLUSIONS
Our results indicate that non-cardioembolic causes, such as macro- and microangiopathy, are important mechanisms in the pathogenesis of cryptogenic stroke.

Keyword

Ischemic stroke; Diffusion-weighted imaging; Magnetic resonance imaging; Risk factors; Stroke classification

MeSH Terms

Arteries
Atherosclerosis
Foramen Ovale, Patent
Humans
Infarction
Magnetic Resonance Imaging
Risk Factors
Stroke*

Figure

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  Figure 1 DWI lesion patterns.

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  Figure 2 DWI lesion patterns in each stroke subtype.

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  Figure 3 DWI lesion patterns depending on the age of symptom onset in patients with cryptogenic stroke.

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  Figure 4 DWI lesion patterns depending on the time of vascular study in patients with cryptogenic stroke (left) and atherosclerotic stroke (right).

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