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So, we'll talk first about cardiovascular infarctions,

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and they tend to have this pattern

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that you can see in this case,

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where there are multiple infarctions

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in multiple vascular distributions.

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You can see lesions in the cerebellum.

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The bilateral occipital and temporal lobes,

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the corpus callosum, the deep gray nuclei,

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and in the cortex and the frontal and prital lobes.

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And you'll notice that many of these

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lesions are in a border zone distribution,

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here between the MCA and ACA,

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bilaterally,

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and here between the MCA and PCA.

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And, of course, this is a PCA infarction,

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and these are predominantly

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border zone infarctions.

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You can see border zone infarctions because

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tiny little emboli end up in the

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border zones or because a patient

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has systemic hypotension.

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Cardiac sources,

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the most common is atrial fibrillation

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and myocardial infarction,

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followed by other entities.

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Cardiovascular infarction can also be caused by

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systemic hypotension or hypercoagulable states,

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and a fair number are hemorrhagic as well.

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This is an example of cardioembolic infarctions.

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These are images of a 77-year-old

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who had mental status change,

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hyperlipidemia, a hypercoagulable state,

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and atrial fibrillation.

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And these are the diffusion images

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and the ADC images.

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And you can see multiple bilateral

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cerebellar infarctions.

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And you know that they're acute to subacute

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because they're bright on DWI and dark on ADC.

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And you can see multiple infarctions

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in the bilateral occipital lobes

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and the bilateral parietal lobes

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and the frontal lobes.

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And you can notice that many of these infarctions

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are in a border zone distribution

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between the ACA and the MCA, superiorly,

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and between the MCA and the PCA more inferiorly.

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There's also a lesion in the posterior

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left putamen, as well as the left caudate.

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And this pattern is very characteristic

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of cardioembolic infarctions.

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When you have tiny emboli,

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they end up in the border zones.

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Some of the lesions are more peripheral

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and are more in an MCA distribution

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or more in a distal PCA distribution.

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So, this is classic for cardioembolic infarctions.

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I just wanted to show you the

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FLAIR images as well.

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So here's a FLAIR image,

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and you can just see that the lesions are

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hyperintense on FLAIR images as well.

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They're kind of subacute infarctions,

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probably over 6 hours.

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Now, we also did an MRA at the time.

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And as you'd expect,

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the MRA looks pretty normal.

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You can see the bilateral MCAs

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and ACAs and ICAs look normal.

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And here's the posterior circulation,

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the vertebral arteries, basilar artery,

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bilateral PCAs look normal as well.

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And

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the raw data, again, just confirms this

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normal anterior and posterior circulations.

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So, when we got the MR,

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we only got the MRA of the head.

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So, we further got a CTA of the neck

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to make sure there wasn't a source in the neck.

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And here's the CTA of the neck,

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and you can see the arch and

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the left subclavian artery.

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And here's the left vertebral artery,

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and you can follow it all the way up,

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and that just looks normal.

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And the right vertebral artery is coming off

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the right subclavian, and can follow that

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all the way up, and that also looks normal.

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And then,

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you can follow the left common up,

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the bifurcation looks clean,

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there's no plaque,

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so that looks normal.

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And then the right side,

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right common carotid bifurcation

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looks completely normal.

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So, you have basically no significant disease

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in the neck or head,

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and

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lesions that look classic for

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cardioembolic infarction

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in a patient with atrial fibrillation.