Brain Embolism Associated with Nonvalvular Atrial Fibrillation Investigated for Clinical Features

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  • Tamai Nobuaki
    Department of Internal Medicine, Kitasato University School of Medicine
  • Kanda Tadashi
    Department of Internal Medicine, Kitasato University School of Medicine
  • Akiyama Hisanao
    Department of Internal Medicine, Kitasato University School of Medicine
  • Iizuka Takahiro
    Department of Internal Medicine, Kitasato University School of Medicine
  • Akutsu Tsugio
    Department of Internal Medicine, Kitasato University School of Medicine
  • Itagaki Hitoshi
    Department of Internal Medicine, Kitasato University School of Medicine
  • Kitai Norio
    Department of Internal Medicine, Kitasato University School of Medicine
  • Hata Takashi
    Department of Internal Medicine, Kitasato University School of Medicine
  • Sakai Fumihiko
    Department of Internal Medicine, Kitasato University School of Medicine

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Other Title
  • 心房細動に伴う脳塞栓症についての臨床的検討

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Abstract

Although nonvalvular atrial fibrillation (NVAF) is an important cause of cerebral infarction in older patients, little is available concerning the clinical features of brain embolism associated with NVAF. To clarify the clinical features of brain embolism in NVAF, we studied the disorder in 110 consecutive patients (71 male, 39 female), 37 to 93 years old (mean age±SD=70.0±11.6 years). The patients were admitted to hospital within 48 hours of stroke onset, and 55(50%) had hypertension, 18(16%) had diabetes mellitus, and 11(10%) had a history of both hypertension and diabetes mellitus. The site and extensiveness of infarction were determined by computerized tomography (CT) and clinical symptoms. To assess the effect of brain embolism on the activities of daily living (ADL), comparisons were made with the mobility of 272 patients of brain thrombosis. In 36(33%) cases of brain embolism the initial diagnosis of atrial fibrillation was made coincidentally with that of stroke onset, and in 20(18%) cases the brain infarction was concomitant with paroxysmal atrial fibrillation (PAF). The infarctions were located in the territory of the carotid system in 93(85%) of the patients and in the vertebrobasilar system in 17(15%). In a markedly high number of patients, 48(43%), the infarct was large, extending over 70% of the cerebral lobe. Brain embolism associated with NVAF resulted in notably poor functionality, with 35% of the patients requiring a wheelchair or being bedridden in contrast to 24% of those with brain thrombosis. A one-month fatality rate of 18% was observed in the embolism group, compared with 10% in the thrombosis group. Recurrent embolism was incurred in 19 patients, 10(53%) within a year of the initial stroke. The activities of daily living were markedly disrupted by stroke recurrence. These results indicate a clustering of stroke events shortly after the onset of either atrial fibrillation or paroxysmal atrial fibrillation, suggesting that patients with recent onset of NVAF or PAF are at high risk or stroke.

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