Mucosa-associated lymphoid tissue (MALT) lymphoma (ML) is a type of non-Hodgkin’s lymphoma involving MALT, commonly the stomach or salivary glands, although virtually any mucosal site can be affected. ML originates from B cells in the marginal zone of MALT, and is also called extranodal marginal zone B cell lymphoma. It is a slow-growing cancer that usually responds well to treatment. A 59-year-old female presented with a 1-day history of quadriparesis and dysarthria. Up arrival at the hospital, motor power in the right upper and lower extremities was grade 3/5 according to the Medical Research Council scale, while that in the left leg was 4/5. The patient had been diagnosed with gastric ML 1 year prior, and had received antibiotics during the previous 2 weeks. The emergency magnetic resonance imaging of the brain performed at the time of presentation showed multifocal embolic infarction in the cerebral hemisphere bilaterally, which did not have a cardiac origin. Magnetic resonance angiography revealed no stenotic or occlusive lesions. Secondary prophylaxis with daily administration of 300 mg aspirin was prescribed. The patient was discharged with residual right hemiparesis 2 weeks after the onset of symptoms. Herein, we present a rare case of multifocal cerebral infarction in a gastric ML patient.

Transient ischemic attack (TIA) indicates high risk for major stroke and is considered a medical emergency. Diffusion-weighted imaging (DWI) enables detection of acute ischemic lesions. The clinical significance of DWI positive lesions in TIA is obscure and its prevalence, clinical features are not established. Therefore, we performed a clinical, etiological and prognostic analysis through a cross-sectional analysis of 235 TIA patients, grouped according to presence of DWI lesion. Clinical features, underlying risk factors for stroke, outcome and rate of recurrence were analyzed. 3 months follow-up of modified Rankin Scales (mRS) were done with telephone survey. DWI positive lesions were present in 14.0% of patients. Etiological factors significantly associated with DWI lesions in TIA patients were male sex (p = 0.038), stroke history (p = 0.012) and atrial fibrillation (p < 0.001). Presence of at least one medium or high risk of cardioembolism from TOAST classification were not associated with lesions when excluding association to atrial fibrillation (p = 0.108). Clinical features showed no significant difference. Whether the patients had lesion-positive DWI was not related to an increase in mRS score during the hospital stay or at the 3-month follow-up after discharge. Future studies should include multi-center samples with large numbers, considering each unique medical environment. Routine acquisition of follow-up DWI for proper evaluation of the tissue-based definition of TIA should also be considered.

Background and Purpose: The Ankle-Brachial Index (ABI) is the ratio of blood pressure in the lower legs to that in the arms. The intima-media thickness (IMT) of extracranial carotid arteries determined by B-mode ultrasound is a measurable index of the presence of atherosclerosis. A low ABI and a high carotid IMT are independently related to increased risk of cardiovascular events. This study examined the association between carotid IMT and ABI in patients with ischemic stroke. Materials and Methods: Retrospectively, 116 hospitalized patients with ischemic stroke were recruited. Using a pulse wave velocity ABI device along with carotid duplex sonography, we measured carotid IMT and ABI and investigated the correlation between average values. Results: There was a significant difference in carotid IMT between the normal and abnormal ABI groups (P=0.0262). The group with an abnormal ABI was more than five times as likely to have increased carotid IMT as the group with a normal ABI (age, sex-adjusted OR 5.67 (95% CI 1.85~17.38)). The ABI and carotid IMT showed a weak inverse linear correlation in patients with ischemic stroke (correlation coefficient −0.378 after adjusting for age and sex). Conclusion: Our study suggests that an abnormal ABI is associated with a high carotid IMT in patients with ischemic stroke.