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Objective Although the body mass index (BMI) is considered a meaningful parameter for evaluating obesity, the association between the BMI and acute non-cardioembolic stroke remains unclear. We investigated how the BMI was related to patients' background, type of infarction, and infarction location in patients with non-cardioembolic stroke using an acute dual study (ADS) cohort. Methods The ADS trial was conducted between May 2011 and June 2017 in Japan. The BMI classifications were those proposed by the World Health Organization classification: underweight, <18.5 kg/m 2 ; normal weight, 18.5-24.9 kg/m 2 ; overweight, 25-29.9 kg/m 2 ; and obese, ≥30 kg/m 2 . Results Data from 1,136 patients were analyzed. The median BMI was 23.6 kg/m 2 (interquartile range: 21.6-25.8 kg/m 2 ), with a BMI ≥30 kg/m 2 in 63 patients (6%), 25-29.9 kg/m 2 in 321 (28%), 18.5-24.9 kg/m 2 in 692 (61%), and <18.5 kg/m 2 in 60 (5%). The group with a BMI ≥30 kg/m 2 was the youngest, and the group with a BMI <18.5 kg/m 2 was the oldest (p<0.001). The proportion of patients with a history of hypertension (p<0.001), diabetes (p<0.001), dyslipidemia (p<0.001), and statin therapy (p=0.005) increased with increasing BMI. Pontine infarcts were frequent in the following order: obese, overweight, normal weight, and underweight (24%, 18%, 14%, and 13%, respectively; p=0.034). In contrast, cortical infarct were frequent in the order of underweight, normal weight, overweight, and obese at 20%, 19%, 14%, and 3%, respectively (p=0.007). Conclusion Acute stroke patients with a high BMI have more atherosclerosis-related factors in their backgrounds than those with lower BMIs. In addition, the BMI may be a determinant of infarct location in patients with acute stroke.

Libman-Sacks endocarditis is an important cause of embolic stroke in systemic lupus erythematosus, although the detailed pathogenesis of stroke remains unclear. We herein report two cases of stroke with Libman-Sacks endocarditis in which the emboli were retrieved by mechanical thrombectomy. The embolus consisted of eosinophilic homogeneous acellular structures, whereas fibrin-platelet thrombi were hardly observed in the embolus. Immunohistochemistry showed immunoglobulin deposits in the embolus, suggesting that immunological mechanisms were involved in the growth of the embolus. A pathological analysis of the embolus retrieved by mechanical thrombectomy provided useful information on the etiology, leading to optimal treatment.

Background: Plasma brain natriuretic peptide (BNP) is used as a marker of congestive heart failure. Moreover, plasma BNP levels are increased in patients with acute ischemic stroke, in particular, cardioembolic stroke. We investigated whether the plasma BNP level can also be used as a biological marker to differentiate specific stroke subtype, in particular cardioembolic stroke from the other ischemic stroke subtypes., Methods: Consecutive patients (total 200; 124 males, 76 females; mean age, 71.4 years) with acute ischemic stroke within 24 hours of onset were prospectively enrolled. We measured plasma BNP on admission. Patients were divided into four groups according to the TOAST classification: large-vessel disease (LVD), cardioembolism (CE), small-vessel disease (SVD), and other stroke. Correlation between plasma BNP level and stroke subtype was then examined., Results: Cardioembolism (41%) was the most frequent stroke subtype, followed by other stroke (34%), SVD (16%), and LVD (9%). Age, female, atrial fibrillation, NIHSS score > or = 7 on admission and mRS score > or = 3 at discharge were significantly higher in CE than in the other stroke subtypes. The mean plasma BNP level of the CE group was significantly higher than that of the other 3 subtypes (409.6 pg/mL for CE, 94.0 pg/mL for LVD, 37.4 pg/mL for SVD, and 156.9 pg/mL for others, p<0.001). The optimal cut-off concentration, sensitivity, and specificity of plasma BNP levels to distinguish CE from other stroke subtypes were 140.0 pg/mL, 80.5% and 80.5%, respectively., Conclusion: Plasma BNP level is significantly higher in CE patients than in other stroke subtypes, and thus physicians should strongly consider CE when the plasma BNP level is over 140.0 pg/mL in patients with acute ischemic stroke.

In a patient with acute cardioembolic stroke, ultrasonographic studies demonstrated the disappearance of an oscillating intraluminal thrombus lodged at the carotid bifurcation. Following the commencement of immediate anticoagulation, the thrombus completely dissolved over two weeks without further deterioration in the patient's symptoms. Neurosonographic studies are useful for the detection and follow-up of an intraluminal thrombus in acute stroke patients undergoing anticoagulant therapy.

Objective: The aim of this study was to clarify the characteristics of transient ischemic attack (TIA) patients with atrial fibrillation (AF) compared to those without., Methods: We divided 67 TIA patients with left hemispheric involvement into two groups; patients with AF (AF group) and without AF (Non-AF group) and compared the clinical characteristics between the two groups., Patients: AF group included 12 patients (73.0 +/- 9.7 years old) and the Non-AF group 55 patients (64.1 +/- 9.8 years old)., Results: Clinically, arterial disease was less frequently seen in the AF group than in the Non-AF group (17% vs 53%, p = 0.028). No significant differences were observed between the two groups in the duration (< 1 hour; AF vs Non AF group: 50% vs 32%) or number of TIAs (more than 1; 17% vs 37%), use of anticoagulation or antiplatelet at time of symptom onset (34% vs 14%), past history of stroke and TIA (58% vs 38%) and ischemic heart diseases (8% vs 13%), and risk factors for atherosclerosis including hypertension (42% vs 71%), diabetes mellitus (17% vs 31%), hyperlipidemia (17% vs 47%), smoking (50% vs 51%) and other emboligenic cardiac diseases except for AF (0% vs 4%). Aphasia was observed more frequently in the AF group than in the Non-AF group (67% vs 20%, p = 0.003), whereas, hemiparesis without aphasia was seen less frequently in the AF group than in the Non-AF group (17% vs 55%, p = 0.025)., Conclusion: TIA patients with AF are more likely than those without AF to exhibit a major hemispheric syndrome, such as aphasia.