Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Mar;70(3):344–349. doi: 10.1136/jnnp.70.3.344

Atrial fibrillation with small subcortical infarcts

D Jung 1, G Devuyst 1, P Maeder 1, J Bogousslavsky 1
PMCID: PMC1737284  PMID: 11181856

Abstract

OBJECTIVES—To evaluate the characteristics of cardioembolic small (maximum lesion diameter<1.5 cm) subcortical infarcts (SSI) in patients with atrial fibrillation (AF).
METHODS—Twenty seven patients with chronic AF and an isolated SSI established by CT/MRI in the anterior circulation (SSI-AF group) were evaluated and their characteristics compared with those of 45 age matched (±1 year) patients with SSI, but no arterial or cardiac embolic source (SSI-control group). Using the criterion of the presence or absence of established risk factors (hypertension or diabetes mellitus) for small artery disease (SAD), the SSI-AF group we also subdivided into two groups, SSI-AF-SAD+ (n=22) and SSI-AF-SAD− (n=5) and their characteristics compared.
RESULTS—Although the lack of any significant difference in the distribution of hypertension and diabetes mellitus between the SSI-AF and SSI-control groups emphasises SAD as a common cause of infarct in SSI-AF, the presence of AF—together with the higher frequency of neuropsychological disturbances in the SSI-AF group versus the SSI-control group (15% v 2%; p=0.066)—favours cardioembolism as a potential cause of infarct in several patients. The characteristic factors seen more often in the SSI-AF-SAD− group compared with the SSI-AF-SAD+ group were secondary haemorrhagic transformation, faciobrachial pure motor weakness, subinsular involvement, and better recovery of neurological deficits.
CONCLUSIONS—The study suggests that either SAD or cardioembolism can be the cause of SSI in patients with AF. Atrial fibrillation is not always coincidental in patients with SSI and a clinical lacunar stroke. Certain clinical and radiological findings may be useful in differentiating cardioembolism from SAD in patients with SSI.



Full Text

The Full Text of this article is available as a PDF (202.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aleksic S. N., George A. E. Pure motor hemiplegia with occlusion of the extracranial carotid artery. J Neurol Sci. 1973 Jul;19(3):331–339. doi: 10.1016/0022-510x(73)90096-8. [DOI] [PubMed] [Google Scholar]
  2. Arboix A., Marti-Vilalta J. L. Presumed cardioembolic lacunar infarcts. Stroke. 1992 Dec;23(12):1841–1842. doi: 10.1161/01.str.23.12.1841. [DOI] [PubMed] [Google Scholar]
  3. Arboix A., Martí-Vilalta J. L., García J. H. Clinical study of 227 patients with lacunar infarcts. Stroke. 1990 Jun;21(6):842–847. doi: 10.1161/01.str.21.6.842. [DOI] [PubMed] [Google Scholar]
  4. Ay H., Oliveira-Filho J., Buonanno F. S., Ezzeddine M., Schaefer P. W., Rordorf G., Schwamm L. H., Gonzalez R. G., Koroshetz W. J. Diffusion-weighted imaging identifies a subset of lacunar infarction associated with embolic source. Stroke. 1999 Dec;30(12):2644–2650. doi: 10.1161/01.str.30.12.2644. [DOI] [PubMed] [Google Scholar]
  5. Bamford J., Sandercock P., Jones L., Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke. 1987 May-Jun;18(3):545–551. doi: 10.1161/01.str.18.3.545. [DOI] [PubMed] [Google Scholar]
  6. Bamford J., Sandercock P., Jones L., Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke. 1987 May-Jun;18(3):545–551. doi: 10.1161/01.str.18.3.545. [DOI] [PubMed] [Google Scholar]
  7. Barinagarrementeria F., Del Brutto O. H. Lacunar syndrome due to neurocysticercosis. Arch Neurol. 1989 Apr;46(4):415–417. doi: 10.1001/archneur.1989.00520400075022. [DOI] [PubMed] [Google Scholar]
  8. Bogousslavsky J. The plurality of subcortical infarction. Stroke. 1992 May;23(5):629–631. doi: 10.1161/01.str.23.5.629. [DOI] [PubMed] [Google Scholar]
  9. Bogousslavsky J., Van Melle G., Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988 Sep;19(9):1083–1092. doi: 10.1161/01.str.19.9.1083. [DOI] [PubMed] [Google Scholar]
  10. Cacciatore A., Russo L. S., Jr Lacunar infarction as an embolic complication of cardiac and arch angiography. Stroke. 1991 Dec;22(12):1603–1605. doi: 10.1161/01.str.22.12.1603. [DOI] [PubMed] [Google Scholar]
  11. Donnan G. A., Bladin P. F., Berkovic S. F., Longley W. A., Saling M. M. The stroke syndrome of striatocapsular infarction. Brain. 1991 Feb;114(Pt 1A):51–70. [PubMed] [Google Scholar]
  12. Feinberg W. M., Blackshear J. L., Laupacis A., Kronmal R., Hart R. G. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995 Mar 13;155(5):469–473. [PubMed] [Google Scholar]
  13. Fisher C. M. Capsular infarcts: the underlying vascular lesions. Arch Neurol. 1979 Feb;36(2):65–73. doi: 10.1001/archneur.1979.00500380035003. [DOI] [PubMed] [Google Scholar]
  14. Fisher C. M., Pearlman A. The nonsudden onset of cerebral embolism. Neurology. 1967 Nov;17(11):1025–1032. doi: 10.1212/wnl.17.11.1025. [DOI] [PubMed] [Google Scholar]
  15. Foulkes M. A., Wolf P. A., Price T. R., Mohr J. P., Hier D. B. The Stroke Data Bank: design, methods, and baseline characteristics. Stroke. 1988 May;19(5):547–554. doi: 10.1161/01.str.19.5.547. [DOI] [PubMed] [Google Scholar]
  16. Fredericks R. K., Lefkowitz D. S., Challa V. R., Troost B. T. Cerebral vasculitis associated with cocaine abuse. Stroke. 1991 Nov;22(11):1437–1439. doi: 10.1161/01.str.22.11.1437. [DOI] [PubMed] [Google Scholar]
  17. Futrell N., Millikan C., Watson B. D., Dietrich W. D., Ginsberg M. D. Embolic stroke from a carotid arterial source in the rat: pathology and clinical implications. Neurology. 1989 Aug;39(8):1050–1056. doi: 10.1212/wnl.39.8.1050. [DOI] [PubMed] [Google Scholar]
  18. Gandolfo C., Caponnetto C., Del Sette M., Santoloci D., Loeb C. Risk factors in lacunar syndromes: a case-control study. Acta Neurol Scand. 1988 Jan;77(1):22–26. doi: 10.1111/j.1600-0404.1988.tb06968.x. [DOI] [PubMed] [Google Scholar]
  19. Gautier J. C. Stroke-in-progression. Stroke. 1985 Jul-Aug;16(4):729–733. doi: 10.1161/01.str.16.4.729. [DOI] [PubMed] [Google Scholar]
  20. Horowitz D. R., Tuhrim S., Weinberger J. M., Rudolph S. H. Mechanisms in lacunar infarction. Stroke. 1992 Mar;23(3):325–327. doi: 10.1161/01.str.23.3.325. [DOI] [PubMed] [Google Scholar]
  21. Hupperts R. M., Lodder J., Heuts-van Raak E. P., Kessels F. Infarcts in the anterior choroidal artery territory. Anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome. Brain. 1994 Aug;117(Pt 4):825–834. doi: 10.1093/brain/117.4.825. [DOI] [PubMed] [Google Scholar]
  22. Kobayashi S., Okada K., Yamashita K. Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors. Stroke. 1991 Nov;22(11):1379–1383. doi: 10.1161/01.str.22.11.1379. [DOI] [PubMed] [Google Scholar]
  23. Laloux P., Brucher J. M. Lacunar infarctions due to cholesterol emboli. Stroke. 1991 Nov;22(11):1440–1444. doi: 10.1161/01.str.22.11.1440. [DOI] [PubMed] [Google Scholar]
  24. Lammie G. A., Brannan F., Wardlaw J. M. Incomplete lacunar infarction (Type Ib lacunes) Acta Neuropathol. 1998 Aug;96(2):163–171. doi: 10.1007/s004010050877. [DOI] [PubMed] [Google Scholar]
  25. Levine R. L., Lagreze H. L., Dobkin J. A., Turski P. A. Large subcortical hemispheric infarctions. Presentation and prognosis. Arch Neurol. 1988 Oct;45(10):1074–1077. doi: 10.1001/archneur.1988.00520340028006. [DOI] [PubMed] [Google Scholar]
  26. Libman R. B., Wirkowski E., Neystat M., Barr W., Gelb S., Graver M. Stroke associated with cardiac surgery. Determinants, timing, and stroke subtypes. Arch Neurol. 1997 Jan;54(1):83–87. doi: 10.1001/archneur.1997.00550130063017. [DOI] [PubMed] [Google Scholar]
  27. Macdonald R. L., Kowalczuk A., Johns L. Emboli enter penetrating arteries of monkey brain in relation to their size. Stroke. 1995 Jul;26(7):1247–1251. doi: 10.1161/01.str.26.7.1247. [DOI] [PubMed] [Google Scholar]
  28. Millikan C., Futrell N. The fallacy of the lacune hypothesis. Stroke. 1990 Sep;21(9):1251–1257. doi: 10.1161/01.str.21.9.1251. [DOI] [PubMed] [Google Scholar]
  29. Mohr J. P., Caplan L. R., Melski J. W., Goldstein R. J., Duncan G. W., Kistler J. P., Pessin M. S., Bleich H. L. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology. 1978 Aug;28(8):754–762. doi: 10.1212/wnl.28.8.754. [DOI] [PubMed] [Google Scholar]
  30. Mohr J. P. Lacunes. Stroke. 1982 Jan-Feb;13(1):3–11. doi: 10.1161/01.str.13.1.3. [DOI] [PubMed] [Google Scholar]
  31. Murgatroyd F. D., Camm A. J. Atrial arrhythmias. Lancet. 1993 May 22;341(8856):1317–1322. doi: 10.1016/0140-6736(93)90824-z. [DOI] [PubMed] [Google Scholar]
  32. Nakamura K., Saku Y., Ibayashi S., Fujishima M. Progressive motor deficits in lacunar infarction. Neurology. 1999 Jan 1;52(1):29–33. doi: 10.1212/wnl.52.1.29. [DOI] [PubMed] [Google Scholar]
  33. Ott A., Breteler M. M., de Bruyne M. C., van Harskamp F., Grobbee D. E., Hofman A. Atrial fibrillation and dementia in a population-based study. The Rotterdam Study. Stroke. 1997 Feb;28(2):316–321. doi: 10.1161/01.str.28.2.316. [DOI] [PubMed] [Google Scholar]
  34. Park Y. D., Belman A. L., Kim T. S., Kure K., Llena J. F., Lantos G., Bernstein L., Dickson D. W. Stroke in pediatric acquired immunodeficiency syndrome. Ann Neurol. 1990 Sep;28(3):303–311. doi: 10.1002/ana.410280302. [DOI] [PubMed] [Google Scholar]
  35. Ringelstein E. B., Biniek R., Weiller C., Ammeling B., Nolte P. N., Thron A. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology. 1992 Feb;42(2):289–298. doi: 10.1212/wnl.42.2.289. [DOI] [PubMed] [Google Scholar]
  36. Ringelstein E. B., Koschorke S., Holling A., Thron A., Lambertz H., Minale C. Computed tomographic patterns of proven embolic brain infarctions. Ann Neurol. 1989 Dec;26(6):759–765. doi: 10.1002/ana.410260612. [DOI] [PubMed] [Google Scholar]
  37. Sacco S. E., Whisnant J. P., Broderick J. P., Phillips S. J., O'Fallon W. M. Epidemiological characteristics of lacunar infarcts in a population. Stroke. 1991 Oct;22(10):1236–1241. doi: 10.1161/01.str.22.10.1236. [DOI] [PubMed] [Google Scholar]
  38. Tuszynski M. H., Petito C. K., Levy D. E. Risk factors and clinical manifestations of pathologically verified lacunar infarctions. Stroke. 1989 Aug;20(8):990–999. doi: 10.1161/01.str.20.8.990. [DOI] [PubMed] [Google Scholar]
  39. Waterston J. A., Brown M. M., Butler P., Swash M. Small deep cerebral infarcts associated with occlusive internal carotid artery disease. A hemodynamic phenomenon? Arch Neurol. 1990 Sep;47(9):953–957. doi: 10.1001/archneur.1990.00530090023007. [DOI] [PubMed] [Google Scholar]
  40. van Merwijk G., Lodder J., Bamford J., Kester A. D. How often is non-valvular atrial fibrillation the cause of brain infarction? J Neurol. 1990 Jun;237(3):205–207. doi: 10.1007/BF00314595. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES