Cerebral embolism after left upper lobectomy caused by a thrombus in the pulmonary vein stump (PVS) is a serious complication. However, it is unclear if cerebral embolism can develop after other types of lobectomy. We present a case of a 68-year-old man with cerebral embolism after left lower lobectomy with a longer PVS than normal. There were no clinically suspected sources for the thrombus except for the PVS. This thrombus seemed to have formed in the PVS. The endovascularly removed thrombus contained scattered nuclear debris around neutrophils, suggesting a physiological response caused by tissue injury.

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<b><i>Introduction:</i></b> Intracerebral hemorrhage (ICH) is a devastating hemorrhagic event and is associated with high mortality or severe neurological sequelae. Age-associated differences in hematoma location for nonlobar ICH are not well known. The aims of the present study were to elucidate the relationship between age and hematoma location and to assess the differences in small-vessel disease (SVD) burden as a potential surrogate marker for longstanding hypertension among various hematoma locations. <b><i>Methods:</i></b> From September 2014 through July 2019, consecutive patients with acute, spontaneous ICH were retrospectively enrolled from a prospective registry. Magnetic resonance imaging was performed during admission, and the total SVD burden score (including microbleeds, lacunes, enlarged perivascular spaces, and white matter hyperintensities) was calculated. The relationships of hematoma location with aging and SVD burden were assessed by using multivariate logistic regression analyses. <b><i>Results:</i></b> A total of 444 patients (156 women [35%]; median age 69 [interquartile range 59–79] years; National Institutes of Health Stroke Scale score 9 [17][3–17]) were enrolled in the present study. Multivariate logistic regression analyses showed that advanced age was independently associated with thalamic (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.19–1.84, <i>p</i> &#x3c; 0.001 for 10-year increment) and lobar hemorrhage (OR: 1.58, 95% CI: 1.19–2.09, <i>p</i> = 0.002) and was independently and negatively related to putaminal hemorrhage (OR: 0.55, 95% CI: 0.44–0.68, <i>p</i> &#x3c; 0.001). The total SVD burden score was independently and positively associated with thalamic hemorrhage (OR: 1.27, 95% CI: 1.01–1.59, <i>p</i> = 0.045) and negatively with lobar hemorrhage (OR: 0.74, 95% CI: 0.55–0.99, <i>p</i> = 0.042), even after adjusting by age, but not with putaminal hemorrhage (OR: 0.91, 95% CI: 0.73–1.14, <i>p</i> = 0.395). <b><i>Conclusion:</i></b> Putaminal, thalamic, and lobar hemorrhages are prone to occur in specific ages and SVD states: putaminal in young patients, thalamic in old and high SVD burden patients, and lobar hemorrhages in old and low SVD burden patients. Susceptibility to bleeding with aging or severe SVD accumulation seems to differ considerably among brain locations.

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Background Paroxysmal atrial fibrillation (AF) is a probable cause of cryptogenic stroke (CS) and AF detection and treatment are important for secondary prevention of stroke. Insertable cardiac monitors (ICMs) are clinically effective in screening for AF and superior to conventional CS follow-up. However, available data are primarily derived from small retrospective studies within Asian cohorts and there is a lack of detailed analyses of differences in patients with and without AF. In this study, we aim to identify the incidence of AF detection and risk stratification criteria within the LOOK (multicenter observational study on detection of atrial fibrillation using insertabLe cardiac mOnitors in patients with cryptOgenic stroKe) registry. Results may benefit patients with CS by enabling clinical practitioners to better predict occult AF and stroke via ICMs. Methods The LOOK registry is a multicenter, prospective, observational study evaluating the proportion, timing, and characteristics of AF detection in patients diagnosed with CS via ICMs. Patient enrolment in this ongoing study started in February 2020 with a target of 200 patients. We are investigating first detection of AF (lasting > 2 minutes) during follow-up at 6, 12, and 24 months via ICM implantation. Patient characteristics, medical history, serum biomarkers, magnetic resonance neuroimaging, atrial cardiomyopathy markers, electrocardiogram readings (including 24-hour Holter electrocardiogram readings), transesophageal echocardiography, cognitive status, stroke recurrence, and functional outcomes are compared between patients with and without AF in this study. Discussion This prospective, multicenter study aims to identify the current status of AF detection in CS patients in Japan. The findings of this study will help identify AF markers and generate a risk scoring system with a novel and superior screening algorithm for occult AF detection, while identifying candidates for ICM implantation and informing the development of diagnostic criteria for CS. Trial registration: UMIN000039809; Registered on 13 Mar 2020