H. Yamanouchi et al., EMBOLIC BRAIN INFARCTION IN NONRHEUMATIC ATRIAL-FIBRILLATION - A CLINICOPATHOLOGICAL STUDY IN THE ELDERLY, Neurology, 48(6), 1997, pp. 1593-1597
Although CT studies have addressed symptomatic and asymptomatic cerebr
al infarctions in nonrheumatic atrial fibrillation (NRAF), pathologic
verification of the results is lacking. The purpose of this study was
to assess the frequency, location, and extent of symptomatic and asymp
tomatic brain infarction in autopsy specimens from elderly patients wi
th NRAF. We examined autopsy specimens from 136 consecutive NRAF patie
nts 70 years of age or older who received no anticoagulant therapy dur
ing their lifetime and compared them with 231 age-matched control subj
ects with similar health histories except for the absence of NRAF. Sym
ptomatic cerebral infarctions were present in 82 (60.3%) NRAF patients
and in 55 (23.8%) control subjects (p < 0.0001). Of symptomatic cereb
ral infarctions, cardioembolic infarction was present in 53 (64.6%) NR
AF patients and in two (3.6%) of the control subjects (p < 0.0001), at
herothrombotic infarction in 13 (15.9%) NRAF patients versus 36 (65.5%
) control subjects (p < 0.0001), and lacunar infarction in four (4.9%)
NRAF patients versus 12 (21.8%) control subjects (p < 0.01). Stroke-r
elated death occurred in 34 (25.0%) NRAF patients and in 18 (7.8%) con
trol subjects (p < 0.0002). Symptomatic cerebral infarction was genera
lly accompanied by asymptomatic infarctions in both NRAF patients and
control subjects. Asymptomatic cortical infarctions were more common i
n NRAF patients, but asymptomatic infarctions in the white matter or d
eep structures were more common in control subjects. In this autopsy s
eries of individuals over 70 years of age, symptomatic brain infarctio
n was 2.5 times more common in NRAF patients than in NRAF-free control
subjects; two-thirds of the infarctions in the NRAF cases were judged
to be cardioembolic in origin. Most asymptomatic cerebral infarctions
in the NRAF patients were located in the cortices.