Hematological disorders related cerebral infarctions are mostly multifocal.

Hematological disorders (HD) have been estimated to implicate approximately 1% of patients with arterial ischemic stroke. However, previously published studies are mostly retrospective or based on case reports or small series in selected young patients. We herein prospectively included consecutive patients with MRI-confirmed cerebral arterial infarctions among individuals admitted in our stroke unit during a 32 month period to determine the clinical and neuroradiological features of ischemic stroke due to HD. Patients with both HD and other identified sources of stroke were excluded. Among patients who were admitted for suspected stroke, 590 had diffusion-weighted MRI confirmed acute arterial infarcts. Cause of the cerebral infarction was HD in 13 patients (2.2%): myeloproliferative disorders (n=4), multiple myeloma (1), lymphoma (1), chronic lymphocytic leukemia (1), disseminated intravascular coagulation (2), thrombotic thrombocytopenic purpura (1), antiphospholipid antibody syndrome (2) and homozygous Q506 factor V mutation associated with lupus anticoagulant (1). The HD were previously known in 6 patients. The only significant difference between the groups of patients with or without HD was the prevalence of multiple acute infarcts in different vascular territories, detected in 53.8% of patients with HD versus 7.8% of patients without HD (mostly due to atherosclerosis, small vessel disease or cardioembolism) (p<0.0001; Fisher exact test). Initial treatment in stroke unit included anticoagulation, steroids, chemotherapy, phlebotomy or plasmatic exchanges, according to etiology. Rankin score at six months was ≤2 in 8 patients. A large spectrum of hematological diseases can be associated with cerebral infarction. In the etiologic work up, HD should be particularly looked for in patients with multifocal acute infarcts to adapt specific therapeutic management.

Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures.

BACKGROUND: Early-onset seizures(ESs) have been reported in 2% to 6% of strokes. Most previous studies have been retrospective and did not systematically perform cerebral magnetic resonance imaging (MRI). OBJECTIVE: To determine the prevalence and determinants of ESs in a prospective cohort. DESIGN: Prospective cohort study. SETTING: Stroke unit in an academic hospital. PATIENTS: Six hundred sixty-one consecutive individuals admitted to our stroke unit during an 18-month period for suspected stroke. MAIN OUTCOME MEASURES: Initial investigations systematically included cerebral MRI. Among patients with MRI-confirmed cerebral infarction, individuals with ES, defined as occurring within 14 days of stroke, were identified. RESULTS: Three hundred twenty-eight patients had MRI-confirmed cerebral infarcts and 178 had cortical involvement. The ESs, all initially partial seizures, occurred in 14 patients (4.3%) and at stroke onset in 5 patients. The ESs occurred exclusively in patients with cortical involvement (P <.001). With infarcts involving the cerebral cortex, there was a higher risk of ESs in watershed infarctions than in territorial strokes (6 of 26 [23.1%] vs 8 of 152 [5.3%], P = .007). Logistic regression analysis showed an almost 4-fold increased risk of ES in patients with watershed infarctions compared with other cortical infarcts (odds ratio, 4.7; 95% confidence interval, 1.5- 15.4; P = .01). Age, sex, diabetes mellitus, hypertension, smoking, National Institutes of Health Stroke Scale score, and cardioembolic origin were not significant risk factors for ES. CONCLUSIONS: The cortical hemispheric location of ischemic strokes is associated with a higher risk of ES. Among these patients, the watershed mechanism is a strong and independent determinant of stroke-related ES.