PMID- 34977369
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220429
IS  - 2405-6502 (Electronic)
IS  - 2405-6502 (Linking)
VI  - 25
DP  - 2021 Dec
TI  - Cholesterol crystal embolism-related cerebral infarction: Magnetic resonance 
      imaging and clinical characteristics.
PG  - 100388
LID - 10.1016/j.ensci.2021.100388 [doi]
LID - 100388
AB  - BACKGROUND AND AIMS: Cholesterol crystal embolism-related cerebral infarction 
      (CCE-CI) is frequently misdiagnosed due to the lack of specific symptoms. To aid 
      in differential diagnosis, this study comprehensively characterized the magnetic 
      resonance imaging (MRI) and clinical manifestations of CCE-CI and compared these 
      features to those of atherothrombotic cerebral infarction (ACI). METHODS: This 
      single-center, retrospective, observational study was conducted at Kitasato 
      University Hospital, Kanagawa, Japan. We identified 37 clinically or 
      histopathologically confirmed CCE-CI cases and 110 ACI cases treated from January 
      2006 to May 2020. Groups were compared for mean age, sex ratio, clinical 
      presentations, imaging manifestations, precipitating factors, comorbid 
      conditions, medications, and smoking history. RESULTS: Of 37 eligible patients 
      with CCE-CI, 10 (27.0%) received brain MRI, of which 8 (21.6%) exhibited 
      high-intensity signals indicative of brain lesions on diffusion-weighted imaging 
      (DWI). However, two patients with DWI lesions exhibited no detectable 
      neurological abnormalities. Patients with CCE-CI frequently demonstrated 
      bilateral DWI lesions involving the bilateral anterior and posterior circulation, 
      a pattern absent in ACI (50% vs. 0%, p < 0.001). Compared to patients with ACI, 
      CCE-CI patients also demonstrated significantly lower estimated glomerular 
      filtration rate (p < 0.001) as well as more frequent eosinophilia (p = 0.006), 
      atherosclerotic plaques >/=4-mm thick in the ascending aorta or proximal arch 
      (p = 0.001), and aortic aneurysm (p < 0.001). CONCLUSIONS: Patients with CCE-CI 
      develop multiple DWI lesions across several vascular territories, even in the 
      absence of neurological symptoms. Comorbid aortic aneurysm may increase CCE-CI 
      risk. These findings could help in the differential diagnosis of CCE-CI.
CI  - (c) 2021 The Authors.
FAU - Kondo, Yuko
AU  - Kondo Y
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
FAU - Kanzaki, Mami
AU  - Kanzaki M
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Ishima, Daisuke
AU  - Ishima D
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Usui, Ryo
AU  - Usui R
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Kimura, Ayato
AU  - Kimura A
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Usui, Kotaro
AU  - Usui K
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Amoh, Yasuyuki
AU  - Amoh Y
AD  - Department of Dermatology, Kitasato University School of Medicine, Kanagawa, 
      Japan.
FAU - Takeuchi, Yasuo
AU  - Takeuchi Y
AD  - Department of Nephrology, Kitasato University School of Medicine, Kanagawa, 
      Japan.
FAU - Kumabe, Toshihiro
AU  - Kumabe T
AD  - Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, 
      Japan.
FAU - Ako, Junya
AU  - Ako J
AD  - Department of Cardiovascular Medicine, Kitasato University School of Medicine, 
      Kanagawa, Japan.
FAU - Miyaji, Kagami
AU  - Miyaji K
AD  - Department of Cardiovascular Surgery, Kitasato University School of Medicine, 
      Kanagawa, Japan.
FAU - Nishiyama, Kazutoshi
AU  - Nishiyama K
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
FAU - Akutsu, Tsugio
AU  - Akutsu T
AD  - Department of Neurology, Kitasato University School of Medicine, Kanagawa, Japan.
AD  - Cerebrovascular Center, Kitasato University Hospital, Kanagawa, Japan.
LA  - eng
PT  - Journal Article
DEP - 20211208
PL  - Netherlands
TA  - eNeurologicalSci
JT  - eNeurologicalSci
JID - 101667077
PMC - PMC8683713
OTO - NOTNLM
OT  - ACI, Atherothrombotic cerebral infarction
OT  - Atheroembolism
OT  - Atherothrombotic cerebral infarction
OT  - CAS, Carotid artery stenting
OT  - CCE, Cholesterol crystal embolism
OT  - CI, Confidence intervals
OT  - CRP, C-reactive protein
OT  - CTA, Computed tomography angiography
OT  - Cerebral infarction
OT  - Cholesterol crystal embolism
OT  - Cholesterol crystal embolism-related cerebral infarction
OT  - DWI, Diffusion-weighted imaging
OT  - Diffusion-weighted imaging
OT  - IRB, Institutional review board
OT  - LDL, Low-density lipoprotein
OT  - MRA, Magnetic resonance angiography
OT  - MRI, Magnetic resonance imaging
OT  - OR, Odds ratios
OT  - PCI, Percutaneous coronary intervention
OT  - TIA, Transient ischemic attack
EDAT- 2022/01/04 06:00
MHDA- 2022/01/04 06:01
PMCR- 2021/12/08
CRDT- 2022/01/03 05:51
PHST- 2021/10/08 00:00 [received]
PHST- 2021/11/30 00:00 [revised]
PHST- 2021/12/04 00:00 [accepted]
PHST- 2022/01/03 05:51 [entrez]
PHST- 2022/01/04 06:00 [pubmed]
PHST- 2022/01/04 06:01 [medline]
PHST- 2021/12/08 00:00 [pmc-release]
AID - S2405-6502(21)00081-2 [pii]
AID - 100388 [pii]
AID - 10.1016/j.ensci.2021.100388 [doi]
PST - epublish
SO  - eNeurologicalSci. 2021 Dec 8;25:100388. doi: 10.1016/j.ensci.2021.100388. 
      eCollection 2021 Dec.