ACUTE MULTIPLE INFARCTION INVOLVING THE ANTERIOR CIRCULATION

Objective: To evaluate the frequency and clinical, topographic, and et iologic patterns of acute multiple infarction involving the anterior c irculation. Design: Data analysis from a prospective acute stroke regi stry in a community-based primary care center. Results: Among 751 pati ents with first ischemic stroke in the anterior circulation over a 4-y ear period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance i maging with gadolinium enhancement, there were four topographic patter ns of infarction: (1) superficial infarcts (11 patients [28%]); (2) su perficial and deep infarcts (12 patients [30%]); (3) deep infarcts (th ree patients [8%]); and (4) infarcts involving the anterior and the po sterior circulation (14 patients [35%]). Both cerebral hemispheres wer e involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed pat ients), transcortical mixed aphasia with hemianopia, and acute pure co gnitive impairment (''dementia''). Large-artery disease was found in 1 3 patients (33%); a cardiac source of embolism was found in 11 patient s (28%); and both were found in three patients (8%). Bilateral infarct s were related to cardioembolism (four patients) and bilateral large-a rtery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. Conclusions: Acute multiple infarcts involving the anterior circulation may be bilateral more freq uently than is currently thought, and they are often associated with p osterior circulation infarcts. They mainly involve the pial hemisphera l territories, commonly being caused by cardioembolism or bilateral ca rotid atheroma. They may be associated with a specific neurologic-neur opsychological dysfunction pattern in up to one fifth of the patients, allowing diagnosis before brain imaging.