This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grau, A. J. Articles by Hacke, W. Search for Related Content PubMed PubMed Citation Articles by Grau, A. J. Articles by Hacke, W. Related Collections Cardiovascular imaging agents/Techniques Acute Cerebral Infarction Embolic stroke Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2002;33:1416.)
© 2002 American Heart Association, Inc.

Short Communication

Lack of Evidence for Pulmonary Venous Thrombosis in Cryptogenic Stroke

A Magnetic Resonance Angiography Study

Armin J. Grau, MD; Stefan O. Schoenberg, MD; Christoph Lichy, MD; Florian Buggle, MD; Michael Bock, PhD Werner Hacke, MD

From the Department of Neurology, University of Heidelberg (A.J.G., C.L., F.B., W.H.), and Department of Radiology, German Cancer Research Center (S.O.S., M.B.), Heidelberg, Germany.

Correspondence to Armin J. Grau, MD, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. E-mail armin_grau{at}med.uni-heidelberg.de

Abstract

Background— Even after extensive evaluation, the etiology of ischemic stroke remains undefined in a considerable proportion of cases, suggesting that causes of stroke may exist that have not yet been established. We tested the hypothesis that pulmonary venous thrombosis (PVT) is a potential source of brain embolism in patients with cryptogenic stroke.

Summary of Report— Within 7 days after mild to moderately severe ischemic stroke or transient ischemic attack, 18 patients (9 women, 9 men; mean age, 48 years) were studied in whom the etiology remained undefined despite complete workup. All patients received high-resolution pulmonary venography with the use of multiple-bolus, multiphase, 3-dimensional, gadolinium-enhanced MR angiography (MRA). Overall quality of the MRA was good in 14 and insufficient in 4 patients, mainly as a result of breathing artifacts. Visualization of the main and segmental veins and evaluability of their patency were good for most right pulmonary veins but often inadequate for left pulmonary veins, particularly for those in the left lower lobe. There was no evidence for PVT in any of the sufficiently visualized pulmonary veins.

Conclusions— The results do not support the hypothesis of PVT as a contributor to the etiology of ischemic stroke. However, the study was limited regarding scan volume, spatial discrimination, patient selection, and delay between ischemia and MRA. Therefore, further investigations, including postmortem studies, are needed to resolve the question of whether PVT may contribute to ischemic stroke.

Key Words: cerebral infarction (etiology) • magnetic resonance angiography • stroke • venous thrombosis

This article has been cited by other articles:

				L. Grosse-Wortmann, A. Al-Otay, H. Woo Goo, C. K. Macgowan, J. G. Coles, L. N. Benson, A. N. Redington, and S.-J. Yoo Anatomical and Functional Evaluation of Pulmonary Veins in Children by Magnetic Resonance Imaging J. Am. Coll. Cardiol., March 6, 2007; 49(9): 993 - 1002. [Abstract] [Full Text] [PDF]