Unilateral

Bilateral

 

88.5%

11.5%

 

n=567

n=74

TOAST

 

 

Cardioembolic (%)

123 (21.8)

22 (30.1)

Large vessel (%)

134 (23.8)

15 (20.6)

Small vessel (%)

141 (25.0)

0 (0.0)

Other etiology

 

 

  Vasculitis (%)

8 (1.4)

5 (6.9)

Hypercoagulable state (%)

11 (2.0)

6 (8.2)

Unknown etiology

 

 

  Cryptogenic >1 cause (%)

13 (2.3)

5 (6.9)

  Cryptogenic no cause (%)

94 (16.7)

12 (16.4)

  Cryptogenic incomplete workup (%)

8 (1.4)

3 (4.1)

Table1 TOAST etiology of patients with restriction on DWI according to unilateral or bilateral MRI findings (n=641).

 

Unilateral

Bilateral

p value

 

88.5%

11.5%

 

n=567

n=74

Demographics

 

 

 

  Age, median (IQR)

63 (3, 103)

62 (19, 98)

0.250

  Gender, no. female (%)

260 (46.2)

39 (52.7)

0.291

  Race, no. African American (%)

376 (66.8)

49 (66.2)

0.195

BMI, median

27.3

27.6

0.349

Past medical history

 

 

 

  Diabetes (%)

166 (29.6)

27 (36.5)

0.025

  Hypertension (%)

417 (74.1)

61 (82.4)

0.207

  Stroke

214 (38.0)

33 (44.6)

0.678

  Coronary artery disease (%)

106 (18.8)

12 (16.2)

0.043

  Atrial fibrillation

52 (9.2)

4 (5.5)

0.021

  Congestive heart failure (%)

40 (7.1)

14 (18.9)

0.000

Atrial fibrillation on telemetry, history, or ECG (%)

62 (11.5)

2 (3.0)

0.032

Baseline laboratory values

 

 

 

  Factor VIII, median (range)

178.3 (67.0, 608.0)

250.9 (90.0, 407.2)

<0.001

  Serum glucose, median (mg/dl) (range)

116 (10, 625)

118 (66, 447)

0.617

  HbA1c, median (range)

5.9 (3.4, 16.0)

5.9 (3.5, 12.8)

0.724

  Triglycerides, median (range)

106 (23, 997)

108 (27, 467)

0.873

  Total cholesterol, median (range)

162 (53, 329)

161 (69, 406)

0.820

  HDL, median (range)

42 (5, 106)

41 (7, 100)

0.363

LDL, median (range)

99 (15, 246)

99 (24, 239)

0.950

  Hematocrit, median (range)

39.5 (17.6, 57.6)

38.3 (19.4, 51.7)

0.093

  Platelets, median (range)

222 (7, 751)

222 (39, 520)

0.556

NIHSS

 

 

 

  Admission, median

5

9

0.006

  Discharge, median

2

5

0.011

mRS

 

 

 

Discharge, median (range)

3 (0-6)

3 (0-6)

0.007

90 days post-discharge, median (range)

2 (0-6)

3 (0-6)

0.080

Table2 Demographics, baseline lab values, and NIHSS characteristics of patients with restriction on DWI according to unilateral or bilateral MRI findings (n=641).

Etiology

Vessel

Circulation

 

Large

Small

Both

Anterior

Posterior

Both

Cardioembolic

14

0

4

7

3

8

Hypercoagulable state

3

1

2

2

1

3

Vasculitis

1

1

3

2

0

3

Large vessel

11

1

0

4

6

2

Catheter-related

2

0

1

2

0

1

Cryptogenic

17

2

1

3

7

10

Other

1

0

0

0

0

1

Total

49

5

11

20

17

28

Table3 Vascular territories involved in patients with bilateral stroke findings on MRI according to vessel size and circulation (n=65). Large vessels include ACA, MCA, PCA, SCA, AICA, PICA, and BA. Small vessels include perforating branches of large vessels. Anterior circulation includes ACA, MCA, and perforating branches of ACA and MCA. Posterior circulation includes PCA, SCA, AICA, PICA, BA, and perforating branches of these large vessels.

 

Unilateral

Bilateral

p value

 

88.5%

11.5%

 

n=567

n=74

Imaging and tests

 

 

 

MRI

 

 

 

  Left acute stroke (%)

185 (28.9)

-

-

  Right acute stroke (%)

177 (27.6)

-

-

MRA head (%)

357 (95.5)

69 (93.2)

0.421

  Intracranial stenosis (%)

139 (39.4)

22 (32.4)

0.275

MRA neck (%)

161 (28.8)

11 (16.7)

0.034

CTA neck (%)

207 (38.9)

28 (43.1)

0.767

Carotid US (%)

174 (32.4)

27 (40.3)

0.196

Extracranial imaging (CUS, MRA neck, CTA neck)

425 (79.0)

54 (80.6)

0.761

TTE (%)

469 (87.3)

59 (89.4)

0.891

  Left atrial enlargement (%)

181 (51.1)

33 (53.2)

0.779

  Ejection fraction <30% (%)

18 (3.5)

5 (7.6)

0.113

TEE

137 (25.5)

28 (42.4)

0.011

Factor VIII

128 (23.8)

27 (40.3)

0.143

Table4 Imaging and tests performed on patients with restriction on DWI according to unilateral or bilateral MRI findings (n=641).

Arterial panel

  Homocysteine

  MTHFR

  Anti-cardiolipin

  Anti-phosphatidylserine

  Beta-2 glycoprotein

  Factor VIII

  Von Willebrand factor antigen

  HIT antibodies

  Dil Russel viper venom test

  Lipoprotein A

Venous panel

  Anti-thrombin III

  Protein C

  Protein S

  Activated protein C resistance

  Factor V Leiden

  Factor II

  Fibrinogen

Auto-immune panel

  CRP

  ESR

  ANA

  dsDNA

  Rhematoid factor

  SS-A

  SS-B

  c-ANCA

  p-ANCA

  Complement 3

  Complement 4

Other

  ACE levels

  Hepatitis panel

  HIV

  RPR

  SPEP

  Hemoglobin electrophoresis

Table5 Hypercoagulation panel ordered for patients suspected of having stroke etiology of hypercoagulable state.

Patient

Imaging

Laboratory tests

CSF analysis

Other conditions

1

angiography

-

-

diagnosis of lupus

2

angiography

-

-

 -

3

vascular imaging other than angiography

high ESR, high CRP

-

 -

4

vascular imaging other than angiography

high CRP

supportive

 -

5

supportive

active encephalitis

Table6 Data supporting diagnosis of vasculitis as etiology in five patients with bilateral stroke.