The differences of clinical parameters between small multiple ischemic lesions and single lesion detected by diffusion-weighted MRI

Objectives - The cause of small infarction is mainly considered to be intracranial small-vessel disease. However, it is difficult to explain the mechanism of multiple, acute infarctions by small-vessel disease. We examined the differences of clinical parameters between patients with multiple small lesions and single lesion detected by Diffusion-weighted MRI (DWI). Material and methods - We reviewed the clinical records of 86 consecutive stroke patients with lacunar size ischemic lesions on DWI during the acute stage (within 72 h of onset). The subjects were 55 males and 31 females (mean age 72.4 +/- 9.9 years). Small multiple acute ischemic lesions were defined using the following criteria 1): the lesions were detectable by DWI 2), the diameter of each lesion on DWI was less than 1.5 cm, and 3) more than one vascular territory was involved. Included in the analysis were age, sex, lipoprotein (a) levels, hematocrit, atrial fibrillation (Af), stenosis of middle cerebral artery (MCA), internal carotid artery (ICA) or basilar artery stenosis detected by magnetic resonance angiography (MRA), National Institute of Health Stroke Scale (NIHSS) at admission, and a history of hypertension, diabetes mellitus, hyperlipidemia, and smoking. Results - Twenty-one (24.4%) out of 86 patients with small acute infarctions had multiple acute ischemic lesions. Multiple logistic regression analysis showed that Af and stenosis of ICA or basilar artery were significantly more prevalent in patients with multiple lesions than single lesions. Conclusion - Multiple, small lesions visible in DWI are likely to be caused by emboli from heart or atheroma of the large vessels than single small lesion.