Prevalence and determinants of subdiaphragmatic visceral infarction in patients with fatal stroke

Background and Purpose - Arterial thromboembolism is a common cause of both visceral and brain infarctions. Because the cause of brain infarction is unknown in up to 39% of patients, the discovery of subdiaphragmatic visceral infarction (SDVI) in this context is important, but its frequency is unknown. We therefore investigated the prevalence of SDVI in subjects who died from stroke. We also evaluated the yield of SDVI diagnosis for stroke subtyping. Methods - We performed a case - control study using a series of 815 consecutive autopsies of patients who had died from a neurological disease, including 350 with stroke ( 260 infarcts and 90 hemorrhages). We systematically assessed the presence of renal, splenic, and mesenteric infarction ( no case of spinal cord was recorded) and analyzed their determinants in patients with stroke. Patients with other neurological diseases served as the control group. Results - Renal infarction was the most frequent SDVI (10.2%), whereas mesenteric infarction was rare ( 1.1%). At least one SDVI was found in 16.9% of patients with stroke (38.7% of patients with a cardioembolic stroke) and in 5.1% of patients with other neurological diseases ( adjusted OR = 2.12; 95% CI = 1.08 to 4.16). Among patients with stroke, a significant heterogeneity in the prevalence of SDVI was found across etiological stroke subgroups with only three patients (3.3%) with hemorrhagic stroke having an SDVI ( 2 mesenteric and one renal infarction) compared with 56 patients (21.5%) with ischemic stroke ( P < 0.0001). Among patients with brain infarction and a SDVI, 76.8% had a definite cardiac source of embolism. Conclusions - In patients with fatal brain infarction, the prevalence of SDVI is higher than previously thought, especially in those with stroke attributed to cardiac emboli. Seeking SDVI may assist in the etiologic diagnosis of brain infarction.