Ter Schiphorst Adrien, Tatu Lavinia, Thijs Vincent, Demattei Christophe, Thouvenot Eric, Renard Dimitri
Department of Neurology, Nîmes University Hospital, Hôpital Carémeau, 4, Rue du Pr Debré, 30029, Nîmes, Cedex 4, France.
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic, Australia.
BMC Neurol. 2019 May 18;19(1):100. doi: 10.1186/s12883-019-1328-0.
A revised classification of cerebellar infarctions (CI) may uncover unrecognized associations with etiologic stroke subtypes. We hypothesized that obliquely oriented small cortical cerebellar infarction (SCCI) representing end zone infarctions on MRI would be associated with cardiac embolism.
We retrospectively analyzed consecutive stroke patients recruited between January-December 2016 in our center. Analyzed baseline characteristics: sex, age, cardiovascular risk factors, history of stroke or atrial fibrillation (AF). TOAST classification was used for determining stroke subtype. Acute infarction location (anterior/posterior/mixed anterior-posterior circulation), acute uni- or multiterritorial infarction, and acute or chronic CI/SCCI/non-SCCI were assessed by MRI, and vertebrobasilar stenosis/occlusion by vessel imaging. Pre-specified analysis was also performed in patients without known high cardioembolic risk (known AF history or acute multiterritorial infarction).
We included 452 patients (CI in 154, isolated SCCI in 55, isolated non-SCCI in 50, and mixed SCCI/non-SCCI in 49). Both SCCI and non-SCCI were associated with AF history (SCCI, p = 0.021; non-SCCI, p = 0.004), additional acute posterior circulation infarction (p < 0.001 both CI-subtypes), multiterritorial infarctions (SCCI, p = 0.003; non-SCCI, p < 0.001) and cardioembolic more frequent than large-artery atherosclerosis origin (p < 0.001 for both CI-subtypes). SCCI was associated with older age (p < 0.001), whereas non-SCCI was associated with stroke history (p = 0.036) and vertebrobasilar stenosis/occlusion (p = 0.002). SCCI were older (p = 0.046) than non-SCCI patients, had less frequently prior stroke (p < 0.001), and more frequent cardioembolic infarction (p = 0.025). In patients without known high cardioembolic risk (n = 348), SCCI was strongly associated with subsequent cardioembolism diagnosis (OR 3.00 [CI 1.58-5.73, p < 0.001]). No such association was present in non-SCCI.
Acute or chronic SCCI are strongly associated with a cardioembolic origin.
小脑梗死（CI）的修订分类可能会发现与病因性卒中亚型未被认识到的关联。我们假设，在MRI上表现为终末区梗死的斜向小皮质小脑梗死（SCCI）与心脏栓塞有关。
我们回顾性分析了2016年1月至12月在我们中心招募的连续卒中患者。分析基线特征：性别、年龄、心血管危险因素、卒中或心房颤动（AF）病史。采用TOAST分类法确定卒中亚型。通过MRI评估急性梗死部位（前循环/后循环/混合前-后循环）、急性单区域或多区域梗死以及急性或慢性CI/SCCI/非SCCI，并通过血管成像评估椎基底动脉狭窄/闭塞情况。还对无已知高心脏栓塞风险（已知AF病史或急性多区域梗死）的患者进行了预先指定的分析。
我们纳入了452例患者（154例CI，55例孤立性SCCI，50例孤立性非SCCI，49例混合性SCCI/非SCCI）。SCCI和非SCCI均与AF病史相关（SCCI，p = 0.021；非SCCI，p = 0.004），额外的急性后循环梗死（两种CI亚型均p < 0.001），多区域梗死（SCCI，p = 0.003；非SCCI，p < 0.001），且心脏栓塞比大动脉粥样硬化起源更常见（两种CI亚型均p < 0.001）。SCCI与年龄较大相关（p < 0.001），而非SCCI与卒中病史（p = 0.036）和椎基底动脉狭窄/闭塞（p = 0.002）相关。SCCI患者比非SCCI患者年龄更大（p = 0.046），既往卒中频率更低（p < 0.001），心脏栓塞性梗死更频繁（p = 0.025）。在无已知高心脏栓塞风险的患者（n = 348）中，SCCI与随后的心脏栓塞诊断密切相关（OR 3.00 [CI 1.58 - 5.73，p < 0.001]）。非SCCI中不存在这种关联。
急性或慢性SCCI与心脏栓塞起源密切相关。
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