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Paradoxical embolism as a cause of silent brain infarctions in healthy subjects: the ICONS study ( I dentification of the C ause of S ilent C erebral I nfarction in H ealthy S ubjects)
Author(s) -
Kim S. J.,
Shin H. Y.,
Ha Y. S.,
Kim J. W.,
Kang K. W.,
Na D. L.,
Bang O. Y.
Publication year - 2013
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2012.03864.x
Subject(s) - medicine , fluid attenuated inversion recovery , stroke (engine) , paradoxical embolism , embolism , cardiology , magnetic resonance imaging , transcranial doppler , neuroimaging , leukoaraiosis , radiology , hyperintensity , psychiatry , mechanical engineering , patent foramen ovale , migraine , engineering
Background In healthy elderly people, silent brain infarctions ( SBI s) have been recognized as common lesions. In this study, we evaluated the association between SBI located outside the perforating artery territory ( PAT ) and paradoxical embolism detected by agitated saline transcranial D oppler ( TCD ) monitoring in healthy subjects. Methods This was a prospective observational study undertaken by a university health promotion center for healthy subjects and by a university stroke center for acute stroke patients. We defined SBI as evidence on fluid‐attenuation inversion recovery ( FLAIR ) magnetic resonance imaging ( MRI ) of one or more infarcts, without history of corresponding stroke or transient ischaemic attack. We also evaluated in all subjects the neuroimaging indicator of microangiopathy leukoaraiosis ( LA ). This study is registered with ClinicalTrials.gov , number NCT 01429948. Results Amongst 1103 consecutive healthy adults who underwent MRI , 347 (31%) had one or more SBI s located outside the PAT , suggesting embolism. Amongst them, 253 subjects underwent agitated saline TCD monitoring and 128 (51%) had right‐to‐left shunts ( RLS ). The prevalence of RLS was similar to cryptogenic embolic stroke (62.0%, P = 0.056), but higher than in patients with other stroke subtypes (36.2%, P = 0.021). Amongst subjects with SBI , absence of LA was the only factor associated with RLS ( OR 1.78; 95% CI 1.01–3.14; P = 0.046). Conclusion Our results suggest that paradoxical embolism may play an important role in the development of SBI outside the PAT in apparently healthy adults.