SIMULTANEOUS SUPRATENTORIAL MULTIPLE CERE BRAL INFARCTS

We assessed the frequency, clinical and etiological correlates of acut e supratentorial multiple infarcts from a hospital-based prospective s troke registry. Among 383 consecutive patients admitted with acute sup ratentorial infarcts, 352 had single infarcts and 31 (8.1 p. 100) had multiple infarcts on computed tomography. Multiple infarcts were bilat eral in 18 patients and unilateral in 13 patients. In only one third o f cases, could the diagnosis of multiple infarcts be suspected clinica lly before neuroimaging. Compared with patients with acute supratentor ial single infarcts, the 18 patients with bilateral acute supratentori al multiple infarcts were younger and had a special etiological profil e. Indeed, an unusual definite cause of stroke was identified in 8 of them, including coagulopathy/systemic disorders or rare non-atheroscle rotic anteriopathy. Major cardiac sources of embolism were identified in 4, whereas large artery artherosclerosis accounted for only 2 cases . In 3 cases, uncertain causes (abnormalities whose link to stroke cou ld not be clearly established) were found. The etiological workup was entirely negative in one. The 13 patients with unilateral acute suprat entorial multiple infarcts did not differ significantly from those wit h acute supratentorial single infarct, concerning age, gender and risk factor profile. In 7 of them, the infarcts involved the anterior circ ulation (with or without associated posterior borderzone infarct). Six had ipsilateral ICA disease and one a major cardioembolic source asso ciated with coaguiopathy. In the other 6 patients, the infarcts involv ed the anterior and posterior circulations. Three had a major cardiac source of embolism and one a multilocal intracranial angiopathy. The c ause of stroke was uncertain in one patient and the etiological workup was entirely negative in another. In conclusion, acute supratentorial multiple infarcts are not rare (8.1 p. 100). A minority of patients ( 32 p. 100) had a clinical picture suggesting multiple infarction. Some topographic patterns were associated with etiological correlates: unu sual causes of stroke (coagulopathy/systemic disorders) and cardioembo lism in bilateral acute supratentorial multiple infarcts; ipsilateral ICA disease in unilateral acute supratentorial multiple infarcts invol ving the anterior circulation (with or without associated posterior bo rdezone infarct); cardioembolism in unilateral supratentorial multiple infarcts involving the anterior and posterior circulations.