| Background and Purpose:Acute multiple cerebral infarction(AMBI)refers to two or more new discontinuous infarcts by diffusion weighted imaging(DWI)in a single stroke event.DWI can find the new ischemic lesions in the first few hours of the onset,detect small infarcts CT is difficult to find,distinguish new ischemic foci,old lesions or nonspecific white matter hyperintensities easily,and confirm the multiple infarcts at the same time.At present,the diameter of infarction less than or equal to 2 cm is recognized as a small infarction,including lacunar infarcts and recent subcortical infarcts who can be single,or multiple,possibly including arteriosclerosis,atherosclerosis and thromboembolism.Clinical and imaging characteristics as well as pathogenic mechanism in the simultaneous small infarctions has not been fully elucidated,not yet reported in Chinese literature.We hypothesized that the different clinical and imaging features and mechanisms may exist.Patients and Methods:Forty-three patients with acute small multiple infarction were collected in this study in Department of Neurology,Shenyang General Military Hospital from November 2011 to December 2016.The initial lesion pattern was categorized as anterior circulation infarction,bilateral anterior circulation infarction,posterior circulation infarction,or anterior/posterior circulation infarction.The age,gender,risk factors,clinical symptoms and neurological deficit score(NIHSS scale),imaging data(including CT,CTA,MRI,DWI,MRA),the short-term prognosis were retrospectively analyzed.Results:There were 31 males and 12 females,aged from 20 to 89 years with an average of 67.7±13.8 years.The time from symptom onset to hospitalization was 1.5 hours to 30 days with an average of 5.9±7.7 days.The main initial symptoms were limb movement disorder,speech disorder and paroxysmal symptoms,accounting for 79%.The baseline NIHSS score was an average of 4.0±4.99,and mild neurologic deficits(from 0 to 6)in 76.7%of the patients.Of 43 cases,there were 17 cases in the anterior circulation infarction,15 in bilateral anterior circulation infarction,9 in the anterior/posterior circulation infarction and 2 in the posterior circulation infarction.The number of lesions in 43 cases was from 3 to 203 with an average of 25.8±33.2.According to the modified TOAST stroke subtype classification criteria,there were 8 cases in large artery atherosclerosis(LAA),17 cases in cardioembolism(CE),14 cases in stroke of undetermined etiology(SUE),4 cases in stroke of other determined etiology(SOE),no case of small artery disease(SAD)in the whole group at al.The patients in this group had relatively good prognosis,32 cases(74.4%)in mRS less or equal to 2 points,11 cases(25.6%)in mRS more or equal to 3 points,and no dead case in the group.Of 43 patients,19 cases(44.2%)had a single territory lesion pattern,24 patients(55.8%)had multiple territory lesion pattern.The age,gender,hypertension,diabetes,Prior stroke,coronary heart disease,heart disease,arrhythmia,abnormal electrocardiogram,peripheral malignancies,cerebral artery stenosis,NIHSS score on admission,mRS score on discharge,stroke subtypes were reviewed and analyzed.The cerebral artery stenosis or occlusion,the numbers of infarct more than 10,and the TOAST stroke subtypes statistically significant different in single territory lesion patterns and multiple territory lesion patterns.Conclusion:Simultaneous small multiple infarction is not uncommon,caused by an embolus from heart or plaque of large artery,mainly presented limb and speech disorder,majority of mild neurological deficits,3/4 patients with good prognosis. |
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