Features of Patients Aged 80 Years or Older with Embolic Stroke of Undetermined Source

J Stroke Cerebrovasc Dis. 2019 Feb;28(2):251-255. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.039. Epub 2018 Oct 24.

Abstract

Background: Embolic stroke of undetermined source has not been thoroughly investigated in older patients. In this study, we investigated the features of this condition in patients greater than or equal to 80 years of age.

Methods: All patients with acute ischemic stroke in our hospital underwent diffusion-weighted imaging, magnetic resonance angiography, T2-weighted imaging, and fluid-attenuated inversion recovery sequence imaging. Embolic stroke of undetermined source was defined as a radiologically confirmed nonlacunar brain infarct on diffusion-weighted imaging without (1) extracranial or intracranial atherosclerosis causing greater than or equal to 50% luminal stenosis in arteries supplying the ischemic area, (2) major-risk cardioembolic source, and (3) any other specific cause of stroke. We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the embolic stroke of undetermined source diagnostic criteria and investigated patients' baseline and diagnostic findings.

Results: We divided 122 consecutive embolic stroke of undetermined source patients (median age: 73 years; 49 men, 73 women) into 2 groups by age at admission. Patients aged greater than or equal to 80 years had higher D-dimer and brain natriuretic peptide levels, more frequent premature atrial complexes/day in 24-hour Holter electrocardiography, and thicker maximum intima media thickness on ultrasound compared with patients aged less than 80 years (P < .05, U test).

Conclusions: Our results suggest that high admission D-dimer and brain natriuretic peptide levels are associated with age of onset in patients with embolic stroke of undetermined source. Patients aged greater than or equal to 80 years tended to have more frequent premature atrial complexes and thicker maximum intima media thickness compared with patients aged less than 80 years.

Keywords: D-dimer; Embolic stroke of undetermined source; brain natriuretic peptide; intima media thickness; premature atrial complexes.

Publication types

  • Comparative Study

MeSH terms

  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Atrial Premature Complexes / complications
  • Atrial Premature Complexes / diagnosis
  • Biomarkers / blood
  • Carotid Intima-Media Thickness
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnosis
  • Cerebral Angiography / methods*
  • Diffusion Magnetic Resonance Imaging*
  • Electrocardiography, Ambulatory
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Intracranial Embolism / blood
  • Intracranial Embolism / diagnosis*
  • Intracranial Embolism / etiology
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis*
  • Stroke / etiology

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Natriuretic Peptide, Brain