|
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 |
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.