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Multiple Embolic Cerebral Infarctions
Karen L. Salzman, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Infarcts in multiple arterial distributions from embolic source, often from cardiac origin or atherosclerotic carotid plaque

          IMAGING

          • Imaging Anatomy

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Goebel J et al: Is histologic thrombus composition in acute stroke linked to stroke etiology or to interventional parameters? AJNR Am J Neuroradiol. 41(4):650-7, 2020
                                    2. Maurer CJ et al: Endovascular thrombectomy of calcified emboli in acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol. 41(3):464-8, 2020
                                    3. Soize S et al: Fast stent retrieval improves recanalization rates of thrombectomy: experimental study on different thrombi. AJNR Am J Neuroradiol. 41(6):1049-53, 2020
                                    4. MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation. Neurology. 93(10):465, 2019
                                    5. Potter CA et al: CT for treatment selection in acute ischemic stroke: a code stroke primer. Radiographics. 39(6):1717-38, 2019
                                    6. Chen Z et al: Prediction of the multisegment clot sign on dynamic CT angiography of cardioembolic stroke. AJNR Am J Neuroradiol. 39(4):663-8, 2018
                                    7. Fonseca AC et al: Cryptogenic stroke. Eur J Neurol. 22(4):618-23, 2015
                                    8. Hasegawa H et al: Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture. J Neurosurg. 1-9, 2015
                                    9. Kim SK et al: Histologic analysis of retrieved clots in acute ischemic stroke: correlation with stroke etiology and gradient-echo MRI. AJNR Am J Neuroradiol. 36(9):1756-62, 2015
                                    10. Meila D et al: Subcallosal artery stroke: infarction of the fornix and the genu of the corpus callosum. The importance of the anterior communicating artery complex. Case series and review of the literature. Neuroradiology. 57(1):41-7, 2015
                                    11. Emiru T et al: Thrombolytic treatment for in-hospital ischemic strokes in United States. J Vasc Interv Neurol. 7(5):28-34, 2014
                                    12. Müller H et al: Embolic and hemodynamic transcranial doppler characteristics in patients with acute ischemic stroke due to carotid occlusive disease: contribution to the different infarct patterns on MRI. J Neuroimaging. 25(5):766-75, 2014
                                    13. Park KY et al: Incidence and risk factors for diffusion-weighted imaging (+) lesions after intracranial stenting and its relationship with symptomatic ischemic complications. Stroke. 45(11):3298-303, 2014
                                    14. Saremi F et al: Paradoxical embolism: role of imaging in diagnosis and treatment planning. Radiographics. 34(6):1571-92, 2014
                                    15. Abenza-Abildua MJ et al: Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient. J Neurol Sci. 284(1-2):209-10, 2009
                                    16. Christian BA et al: Showered calcific emboli to the brain, the 'salted pretzel' sign, originating from the ipsilateral internal carotid artery causing acute cerebral infarction. Stroke. 40(5):e319-21, 2009
                                    17. Emond H et al: From amaurosis fugax to asymptomatic bithalamic infarct. J Neurol. 256(6):1007-8, 2009
                                    18. Iwanaga T et al: Paracentral strip infarcts of the middle cerebral artery: borderzone ischaemia or cortical artery occlusion? Cerebrovasc Dis. 27(3):215-22, 2009
                                    19. Khetarpal V et al: Calcific aortic valve and spontaneous embolic stroke: A review of literature. J Neurol Sci. 287(1-2):32-5, 2009
                                    20. Ralea IC et al: Acute stroke and heart attack management within a four-hour time window. J Stroke Cerebrovasc Dis. 18(2):167-70, 2009
                                    21. Barber PA et al: Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery. Stroke. 39(5):1427-33, 2008
                                    22. Kang SY et al: Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients. Neurology. 70(24 Pt 2):2386-93, 2008
                                    23. Li Q et al: Repeated embolism and multiple aneurysms: central nervous system manifestations of cardiac myxoma. Eur J Neurol. 15(12):e112-3, 2008
                                    24. Alfke K et al: Magnetic resonance imaging of individual cerebral perfusion territories improves the diagnosis of embolic stroke. J Comput Assist Tomogr. 31(6):894-5, 2007
                                    25. Gezer S: Antiphospholipid syndrome. Dis Mon. 49(12):696-741, 2003
                                    26. Provenzale JM et al: Brain infarction in young adults: etiology and imaging findings. AJR Am J Roentgenol. 169(4):1161-8, 1997
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Definitions

                                              • Infarcts in multiple arterial distributions from embolic source, often from cardiac origin or atherosclerotic carotid plaque

                                            IMAGING

                                            • Imaging Anatomy

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Goebel J et al: Is histologic thrombus composition in acute stroke linked to stroke etiology or to interventional parameters? AJNR Am J Neuroradiol. 41(4):650-7, 2020
                                                                      2. Maurer CJ et al: Endovascular thrombectomy of calcified emboli in acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol. 41(3):464-8, 2020
                                                                      3. Soize S et al: Fast stent retrieval improves recanalization rates of thrombectomy: experimental study on different thrombi. AJNR Am J Neuroradiol. 41(6):1049-53, 2020
                                                                      4. MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation. Neurology. 93(10):465, 2019
                                                                      5. Potter CA et al: CT for treatment selection in acute ischemic stroke: a code stroke primer. Radiographics. 39(6):1717-38, 2019
                                                                      6. Chen Z et al: Prediction of the multisegment clot sign on dynamic CT angiography of cardioembolic stroke. AJNR Am J Neuroradiol. 39(4):663-8, 2018
                                                                      7. Fonseca AC et al: Cryptogenic stroke. Eur J Neurol. 22(4):618-23, 2015
                                                                      8. Hasegawa H et al: Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture. J Neurosurg. 1-9, 2015
                                                                      9. Kim SK et al: Histologic analysis of retrieved clots in acute ischemic stroke: correlation with stroke etiology and gradient-echo MRI. AJNR Am J Neuroradiol. 36(9):1756-62, 2015
                                                                      10. Meila D et al: Subcallosal artery stroke: infarction of the fornix and the genu of the corpus callosum. The importance of the anterior communicating artery complex. Case series and review of the literature. Neuroradiology. 57(1):41-7, 2015
                                                                      11. Emiru T et al: Thrombolytic treatment for in-hospital ischemic strokes in United States. J Vasc Interv Neurol. 7(5):28-34, 2014
                                                                      12. Müller H et al: Embolic and hemodynamic transcranial doppler characteristics in patients with acute ischemic stroke due to carotid occlusive disease: contribution to the different infarct patterns on MRI. J Neuroimaging. 25(5):766-75, 2014
                                                                      13. Park KY et al: Incidence and risk factors for diffusion-weighted imaging (+) lesions after intracranial stenting and its relationship with symptomatic ischemic complications. Stroke. 45(11):3298-303, 2014
                                                                      14. Saremi F et al: Paradoxical embolism: role of imaging in diagnosis and treatment planning. Radiographics. 34(6):1571-92, 2014
                                                                      15. Abenza-Abildua MJ et al: Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient. J Neurol Sci. 284(1-2):209-10, 2009
                                                                      16. Christian BA et al: Showered calcific emboli to the brain, the 'salted pretzel' sign, originating from the ipsilateral internal carotid artery causing acute cerebral infarction. Stroke. 40(5):e319-21, 2009
                                                                      17. Emond H et al: From amaurosis fugax to asymptomatic bithalamic infarct. J Neurol. 256(6):1007-8, 2009
                                                                      18. Iwanaga T et al: Paracentral strip infarcts of the middle cerebral artery: borderzone ischaemia or cortical artery occlusion? Cerebrovasc Dis. 27(3):215-22, 2009
                                                                      19. Khetarpal V et al: Calcific aortic valve and spontaneous embolic stroke: A review of literature. J Neurol Sci. 287(1-2):32-5, 2009
                                                                      20. Ralea IC et al: Acute stroke and heart attack management within a four-hour time window. J Stroke Cerebrovasc Dis. 18(2):167-70, 2009
                                                                      21. Barber PA et al: Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery. Stroke. 39(5):1427-33, 2008
                                                                      22. Kang SY et al: Anterior cerebral artery infarction: stroke mechanism and clinical-imaging study in 100 patients. Neurology. 70(24 Pt 2):2386-93, 2008
                                                                      23. Li Q et al: Repeated embolism and multiple aneurysms: central nervous system manifestations of cardiac myxoma. Eur J Neurol. 15(12):e112-3, 2008
                                                                      24. Alfke K et al: Magnetic resonance imaging of individual cerebral perfusion territories improves the diagnosis of embolic stroke. J Comput Assist Tomogr. 31(6):894-5, 2007
                                                                      25. Gezer S: Antiphospholipid syndrome. Dis Mon. 49(12):696-741, 2003
                                                                      26. Provenzale JM et al: Brain infarction in young adults: etiology and imaging findings. AJR Am J Roentgenol. 169(4):1161-8, 1997