Brain Microembolism

Department of Neurology, Department of Radiology, Boston University School of Medicine, Harvard Medical School, MA, USA.
Journal of Neuroimaging (Impact Factor: 1.73). 05/2003; 13(2):140-6. DOI: 10.1177/1051228403251187
Source: PubMed


To alert clinicians about the occurrence of a subtype of brain infarction, its suspected etiology, and its detection by specific neuroimaging techniques.
The article presents 5 nonconsecutive patients admitted to the stroke services of 2 tertiary care hospitals, who presented with acute or subacute symptoms suspicious, but at times atypical, of brain ischemia.
Each patient had evidence of 3 to > 20 small areas of recent brain infarction detected by diffusion-weighted imaging (DWI). When available, brain computerized tomography images were not helpful for the diagnosis of these recent infarcts. Most lesions were present on magnetic resonance imaging fluid-attenuated inversion recovery sequences, but the diffusion-weighted images allowed the determination of their acuity. Further evaluation revealed a potential source of embolism in each patient. Brain microembolism was suspected in all cases.
Small and multiple areas of acute or subacute brain infarction occasionally present with clinical features atypical for brain embolism. They can be detected by magnetic resonance DWI studies.

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    • "Imaging techniques (CT scan, MRI, DWI-MRI) can show “silent” areas of cerebral ischemia. These small and multiple areas of acute or subacute brain infarction may occasionally present with clinical features atypical for brain embolism or will not produce any apparent symptoms [94]. "
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    ABSTRACT: Transcranial Doppler can detect microembolic signals which are characterized by unidirectional high intensity increase, short duration, random occurrence, and a "whistling" sound. Microembolic signals have been detected in a number of clinical settings: carotid artery stenosis, aortic arch plaques, atrial fibrillation, myocardial infarction, prosthetic heart valves, patent foramen ovale, valvular stenosis, during invasive procedures (angiography, percutaneous transluminal angioplasty), surgery (carotid, cardiopulmonary bypass, orthopedic), and in certain systemic diseases. Microembolic signals are frequent in large artery disease, less commonly detected in cardioembolic stroke, and infrequent in lacunar stroke. This article provides an overview about the current state of technical and clinical aspects of microembolus detection.
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    ABSTRACT: Embolism is considered to be the main mechanism leading to brain infarction today; with the introduction of sophisticated neuroimaging tools, its impact is increasingly appreciated. Transcranial Doppler ultrasound allows noninvasive monitoring of in vivo embolism. Acute stroke, internal carotid artery stenosis, several cardiac conditions, internal carotid endarterectomy, and coronary artery bypass graft surgery have been extensively monitored. These investigations and other clinical and neuroimaging studies have expanded the understanding of brain embolism; they suggest it may be appropriate to think of it as a process that occurs in the context of other hemodynamic factors. Differences have been identified among several conditions regarding the temporal profile of embolism and the characteristics of embolic particles. This article presents a brief review of brain embolism monitoring with transcranial Doppler ultrasound.
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