The Study On Stroke Etiologies And Pathogenesis Between Acute Multiple Brain Infarction And Single Brain Infarction

Objective To discuss the stroke etiologies between acute multiple brain infarction and single brain infarction and its possible pathogenesis. Methods In a top three teaching hospital,the DWI data was prospectively assessed in patients with acute first-ever ischaemic stroke within 7 days after the onset of stroke symptoms.The patients were divided into acute multiple brain infarction (AMBI) and acute single brain infarction( ASBI) (control group) according to the lesion patterns on DWI.The stroke etiological subtypes were determined according to the criteria of the Trial of Org 10172 in Acute Stroke Treatment(TOAST).Statistical analyses were performed with the software package of SPSS 13.0,with 2-tailed P<0.05 considered statistically efficient.Results (1)231patients with acute first-ever ischaemic stroke were selected .There were 129 patients in the anterior circulation,69 paients with AMBI,60 patients with ASBI;71 patients in the posterior circulation,28 paients with AMBI,43 patients with ASBI;31 patients involving the anterior and posterior circulation.(2) In 69 patients with AMBI in the anterior circulation,there were 44 patients with large-artery atherosclerotic brain infarction,13 with cardio embolism,3 with small-artery occlusion,4 with stroke of other determined etiologies,and 5 with stroke of undetermined etiologies;In 60 patients with ASBI group,there were 16 patients with large-artery atherosclerotic brain infarction,5 with cardio embolism,34 with small-artery occlusion,2 with stroke of other determined etiologies,and 3 with stroke of undetermined etiologies.Compared with ASBI group,the most frequent cause of stroke was large-artery atherosclerosis in AMBI group(P<0.05) and small-artery occlusion in ASBI group(P<0.05). (3) In 28 patients with AMBI in the posterior circulation,there were 19 patients with large-artery atherosclerotic brain infarction,4 with cardio embolism,2 with small-artery occlusion,1 with stroke of other determined etiologies,and 2 with stroke of undetermined etiologies;In 43 patients with ASBI,there were 10 patients with large-artery atherosclerotic brain infarction,4 with cardio embolism,25 with small-artery occlusion,2 with stroke of other determined etiologies,and 2 with stroke of undetermined etiologies.Compared with ASBI group,The most frequent cause of stroke was large-artery atherosclerosis in AMBI group(P<0.05),and small-artery occlusion in ASBI group(P<0.05).Conclusion (1) The main cause of AMBI in the anterior circulation is large-artery atherosclerosis,the main cause of ASBI in the anterior circulation is small-artery occlusion.(2)Compared with ASBI group,the main cause of AMBI in the posterior circulation is large-artery atherosclerosis.The possible pathogenesis in posterior cerebral artery and superior cerebellar artery territory infarcts is artery-artery embolism or cardiogenic embolism;the possible mechanisms in posterior inferior cerebellar artery is primary atherosclerotic occlusive thrombosis or artery-artery embolism.(3) The main cause of AMBI involving the anterior and posterior circulation is large-artery atherosclerosis,next cardio embolism.Its main pathogenesis is embolism.(4) Compared with ASBI group,large-artery atherosclerosis is more common in AMBI,but embolism mechanism is more often in AMBI involving the anterior and posterior circulation,especially artery-artery embolism.