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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1995 Aug;59(2):132–137. doi: 10.1136/jnnp.59.2.132

Comparison of CT in patients with cerebral ischaemia with or without non-rheumatic atrial fibrillation. European Atrial Fibrillation Trial and Dutch T I A Trial Study Groups.

J van Latum 1, P J Koudstaal 1, L J Kappelle 1, F van Kooten 1, A Algra 1, J van Gijn 1
PMCID: PMC485987  PMID: 7629526

Abstract

In an attempt to distinguish between the CT characteristics of strokes of presumed cardioembolic origin and strokes caused by arterial disease, a comparison was made between the baseline CT of two prospective cohorts of patients with transient ischaemic attack or minor ischaemic stroke, with (n = 985) or without (n = 2987) non-rheumatic atrial fibrillation (NRAF). Of the patients with NRAF 54% had evidence of cerebral infarction v 41% of the controls (patients with sinus rhythm (SR); odds ratio (OR) 1.7; 95% confidence interval (95% CI) 1.4-1.9). Patients with NRAF more often had multiple infarcts (OR 1.4; 95% CI 1.1-1.8), and more often infarcts that were not related to current neurological symptoms (OR 1.5; 95% CI 1.2-1.8). For symptomatic infarcts, patients with NRAF more often had cortical end zone infarcts (OR 3.1; 95% CI 2.6-3.8) and cortical border zone infarcts (OR 1.9; 95% CI 1.3-2.9) than patients with SR. Conversely, symptomatic small deep infarcts (lacunae) were more often seen in patients with SR (OR 3.9; 95% CI 2.8-5.4). Multivariate analyses showed that all these findings were independent of differences in baseline characteristics between the two study groups. The CT characteristics overlapped and did not allow a reliable distinction between cardioembolic and atherosclerotic causes of stroke in patients with NRAF.

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Selected References

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  1. Bogousslavsky J., Van Melle G., Regli F., Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990 Jul;40(7):1046–1050. doi: 10.1212/wnl.40.7.1046. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Boysen G., Nyboe J., Appleyard M., Sørensen P. S., Boas J., Somnier F., Jensen G., Schnohr P. Stroke incidence and risk factors for stroke in Copenhagen, Denmark. Stroke. 1988 Nov;19(11):1345–1353. doi: 10.1161/01.str.19.11.1345. [DOI] [PubMed] [Google Scholar]
  4. Brand F. N., Abbott R. D., Kannel W. B., Wolf P. A. Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study. JAMA. 1985 Dec 27;254(24):3449–3453. [PubMed] [Google Scholar]
  5. Caplan L. R., Hier D. B., D'Cruz I. Cerebral embolism in the Michael Reese Stroke Registry. Stroke. 1983 Jul-Aug;14(4):530–536. doi: 10.1161/01.str.14.4.530. [DOI] [PubMed] [Google Scholar]
  6. D'Olhaberriague L., Hernández-Vidal A., Molina L., Soler-Singla L., Marrugat J., Pons S., Moral A., Pou-Serradell A. A prospective study of atrial fibrillation and stroke. Stroke. 1989 Dec;20(12):1648–1652. doi: 10.1161/01.str.20.12.1648. [DOI] [PubMed] [Google Scholar]
  7. Damasio H. A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol. 1983 Mar;40(3):138–142. doi: 10.1001/archneur.1983.04050030032005. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. Ghika J., Bogousslavsky J., Regli F. Infarcts in the territory of the deep perforators from the carotid system. Neurology. 1989 Apr;39(4):507–512. doi: 10.1212/wnl.39.4.507. [DOI] [PubMed] [Google Scholar]
  10. Harrison M. J., Marshall J. Atrial fibrillation, TIAs and completed strokes. Stroke. 1984 May-Jun;15(3):441–442. doi: 10.1161/01.str.15.3.441. [DOI] [PubMed] [Google Scholar]
  11. Kempster P. A., Gerraty R. P., Gates P. C. Asymptomatic cerebral infarction in patients with chronic atrial fibrillation. Stroke. 1988 Aug;19(8):955–957. doi: 10.1161/01.str.19.8.955. [DOI] [PubMed] [Google Scholar]
  12. Lodder J., Bamford J. M., Sandercock P. A., Jones L. N., Warlow C. P. Are hypertension or cardiac embolism likely causes of lacunar infarction? Stroke. 1990 Mar;21(3):375–381. doi: 10.1161/01.str.21.3.375. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. Olsen T. S., Skriver E. B., Herning M. Cause of cerebral infarction in the carotid territory. Its relation to the size and the location of the infarct and to the underlying vascular lesion. Stroke. 1985 May-Jun;16(3):459–466. doi: 10.1161/01.str.16.3.459. [DOI] [PubMed] [Google Scholar]
  15. Petersen P., Godtfredsen J. Embolic complications in paroxysmal atrial fibrillation. Stroke. 1986 Jul-Aug;17(4):622–626. doi: 10.1161/01.str.17.4.622. [DOI] [PubMed] [Google Scholar]
  16. Petersen P., Madsen E. B., Brun B., Pedersen F., Gyldensted C., Boysen G. Silent cerebral infarction in chronic atrial fibrillation. Stroke. 1987 Nov-Dec;18(6):1098–1100. doi: 10.1161/01.str.18.6.1098. [DOI] [PubMed] [Google Scholar]
  17. Ramirez-Lassepas M., Cipolle R. J., Bjork R. J., Kowitz J., Snyder B. D., Weber J. C., Stein S. D. Can embolic stroke be diagnosed on the basis of neurologic clinical criteria? Arch Neurol. 1987 Jan;44(1):87–89. doi: 10.1001/archneur.1987.00520130067019. [DOI] [PubMed] [Google Scholar]
  18. Santamaria J., Graus F., Rubio F., Arbizu T., Peres J. Cerebral infarction of the basal ganglia due to embolism from the heart. Stroke. 1983 Nov-Dec;14(6):911–914. doi: 10.1161/01.str.14.6.911. [DOI] [PubMed] [Google Scholar]
  19. Witteman J. C., Grobbee D. E., Valkenburg H. A., van Hemert A. M., Stijnen T., Burger H., Hofman A. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet. 1994 Feb 26;343(8896):504–507. doi: 10.1016/s0140-6736(94)91459-1. [DOI] [PubMed] [Google Scholar]
  20. Wolf P. A., Abbott R. D., Kannel W. B. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987 Sep;147(9):1561–1564. [PubMed] [Google Scholar]
  21. Wolf P. A., Dawber T. R., Thomas H. E., Jr, Kannel W. B. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology. 1978 Oct;28(10):973–977. doi: 10.1212/wnl.28.10.973. [DOI] [PubMed] [Google Scholar]
  22. van Gijn J., Kraaijeveld C. L. Blood pressure does no predict lacunar infarction. J Neurol Neurosurg Psychiatry. 1982 Feb;45(2):147–150. doi: 10.1136/jnnp.45.2.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. 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]
  24. van Swieten J. C., Hijdra A., Koudstaal P. J., van Gijn J. Grading white matter lesions on CT and MRI: a simple scale. J Neurol Neurosurg Psychiatry. 1990 Dec;53(12):1080–1083. doi: 10.1136/jnnp.53.12.1080. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. van Swieten J. C., Koudstaal P. J., Visser M. C., Schouten H. J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604–607. doi: 10.1161/01.str.19.5.604. [DOI] [PubMed] [Google Scholar]

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