Coexisting causes of ischemic stroke

Arch Neurol. 2000 Aug;57(8):1139-44. doi: 10.1001/archneur.57.8.1139.


Background: Coexistence of multiple potential causes of cerebral infarct (MPCI) has been poorly studied.

Objective: To determine the risk factors, clinical findings, and topographical patterns of patients with at least 2 potential causes of cerebral infarct.

Design: Data analysis from a prospective acute stroke registry (the Lausanne Stroke Registry, Lausanne, Switzerland) in a community-based primary care center.

Results: Among 3525 patients with first-ever ischemic stroke consecutively admitted to a primary care stroke center, 250 patients (7%) had at least 2 MPCIs, with the following subgroups: large artery disease and a cardiac source of embolism (LAD + CSE) (43%), small artery disease and CSE (SAD + CSE) (34%), LAD + SAD (18%), and LAD + SAD + CSE (5%). Hypertension, cardiac ischemia, and a history of atrial fibrillation predominated in the LAD + SAD + CSE subgroup (P<.001), while cigarette smoking was more prevalent in the LAD + SAD subgroup (P<.05). A decreased level of consciousness and speech disorders were more common in the LAD + CSE subgroup (P<.001). Lacunar syndromes predominated in the LAD + SAD subgroup. Pure motor stroke was the most frequent lacunar syndrome in all subgroups, but sensory motor stroke predominated in the LAD + CSE subgroup (P<.05). The outcome at 1 month was worse in the LAD + CSE and SAD + CSE subgroups (P<.001). Other stroke characteristics and clinical features did not differ significantly between the 4 subgroups of patients with MPCI.

Conclusions: Our findings suggest that MPCIs are uncommon. The most frequent association is LAD + CSE. Topographical patterns of stroke and clinical characteristics in patients with MPCI only rarely allow emphasis of a preeminent cause. Arch Neurol. 2000;57:1139-1144

MeSH terms

  • Aged
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / epidemiology
  • Brain Ischemia / complications*
  • Brain Ischemia / epidemiology*
  • Brain Ischemia / therapy
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / epidemiology
  • Infarction, Middle Cerebral Artery / epidemiology
  • Infarction, Middle Cerebral Artery / etiology
  • Infarction, Middle Cerebral Artery / therapy
  • Intracranial Embolism / complications
  • Intracranial Embolism / epidemiology
  • Intracranial Embolism / therapy
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / etiology*
  • Stroke / therapy
  • Treatment Outcome