Early clinical differentiation of cerebral infarction from severe atherosclerotic stenosis and cardioembolism

S. G. Timsit, R. L. Sacco, J. P. Mohr, M. A. Foulkes, T. K. Tatemichi, P. A. Wolf, T. R. Price, D. B. Hier

Research output: Contribution to journalArticle

168 Scopus citations

Abstract

Background and Purpose: Hyperacute cerebral infarction trials require early differentiation of infarction subtype. Our aim was to determine clinical factors predictive of infarction subtype from data collected in the early hours of admission. Methods: Using the 1,273 patients enrolled in the Stroke Data Bank, stroke risk factors and demographic, clinical, and radiological features were compared between the 246 cardioembolic and 113 large-vessel atherosclerotic cerebral infarcts. Results: Stroke Data Bank definitions ensured more transient ischemic attacks in atherosclerotic infarcts and more cardiac disease in cardioembolic infarcts, but the diagnosis was distinguished further using a logistic regression model. Fractional arm weakness (shoulder different from hand) (odds ratio 3.1, 95% confidence interval [CI] 1.6-5.8), hypertension (odds ratio 2.8, CI 1.4-5.3), diabetes (odds ratio 2.5, CI 1.2-5.1) and male gender (odds ratio=2.2, CI 1.2-4.1) occurred more frequently in patients with atherosclerotic than cardioembolic infarcts. Reduced consciousness (odds ratio=3.2, CI 1.4-7.3) was more frequent in cardioembolism. For a male patient with hypertension, diabetes, and fractional arm weakness, the estimated odds of an atherosclerotic infarction were 47-fold that of a cardioembolic infarction. Patients with atherosclerotic infarcts were more likely to have a fractional arm weakness regardless of infarct size, whereas, for those with cardioembolic infarctions, fractional weakness was more frequent in infarcts less than 20 cc in volume. Conclusions: Clinical features that are observed at stroke onset can help distinguish cerebral infarction subtypes and may allow for early stratification in therapeutic trials.

Original languageEnglish (US)
Pages (from-to)486-491
Number of pages6
JournalStroke
Volume23
Issue number4
DOIs
StatePublished - Apr 1992
Externally publishedYes

Keywords

  • Cardioembolic stroke
  • Cerebral infarction
  • Epidemiology
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

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    Timsit, S. G., Sacco, R. L., Mohr, J. P., Foulkes, M. A., Tatemichi, T. K., Wolf, P. A., Price, T. R., & Hier, D. B. (1992). Early clinical differentiation of cerebral infarction from severe atherosclerotic stenosis and cardioembolism. Stroke, 23(4), 486-491. https://doi.org/10.1161/01.STR.23.4.486