A Comparison of Infarct Size and Prognosis between Cardiogenic Embolic Infarction and Large Artery Atherosclerotic Infarction

J Korean Neurol Assoc > Volume 18(4); 2000 > Article

Journal of the Korean Neurological Association 2000;18(4): 381-385.

심인성 색전과 죽상경화에 의한 뇌경색의 크기 및 예후의 비교

장지훈, 윤병우* † 노재규* †

제주 한마음병원 신경과 서울대학교 의과대학 신경과학교실*,서울대학교 의학연구원 신경과학연구소 †

A Comparison of Infarct Size and Prognosis between Cardiogenic Embolic Infarction and Large Artery Atherosclerotic Infarction

Ji-Hoon Jang, M.D., Byung-Woo Yoon, M.D.* † , Jae-Kyu Roh, M.D.* †

Department of Neurology, Cheju Hanmaeum Hospital Department of Neurology, College of Medicine, Seoul National University*, Neuroscience Research Institute, SNUMRC †

Abstract

Background : Cardiogenic embolic infarction is the most preventable type of ischemic stroke. This study was under-taken to compare the infarct size, prognosis, and risk factors between cardiogenic embolic infarction (CE) and large artery atherosclerotic infarction (LAA). M e t h o d s : We reviewed the medical records and brain computed tomogra-phy/ magnetic resonance image (CT/MRI) scans of patients with CE or LAA during the period between January 1996 and May 1998. Patients with lacunar and posterior circulation infarctions were excluded. A slice of brain CT/MRI scan showing the largest lesion was selected in each patient and the area of infarction was then measured. Prognosis was determined by the Modified Rankin Disability Scale (MRDS) and was grouped as either good (MDRS 0, 1, 2) or poor (MDRS 3, 4, 5). Results : The study included 103 patients : 50 with CE (NVAF in 23, VHD with or without AF in 13, prosthetic valve in 6, and others in 8) and 53 with LAA (large artery thrombosis in 29, and artery to artery embolism in 24). The infarct size of CE (23.2±14.7 츠 2 ) was significantly larger than that of LAA (11.4±10.5 츠 2 ) (p<0.001). The infarct size of NVAF (29.0±19.1 cm 2 ) was significantly larger than that of VHD with or without AF (19.2±11.5 cm 2 ) (p<0.05). Patients with CE had a worse prognosis (poor in 46%) than those with LAA (poor in 23%) (p<0.05). C o n c l u s i o n s : Our results showed that CE led to larger lesions and worse outcomes. Therefore, we emphasize the importance of primary and secondary preventions of stroke in patients with cardiogenic embolic sources. J Korean Neurol Assoc 18(4):381~385, 2000 Key Words : Cardiogenic embolic infarction, Large artery atherosclerotic infarction, Nonvalvular atrial fibrillation, Valvular heart disease, Infarct size, Prognosis