Predictive value of thrombus enhancement and thrombus permeability in cardioembolic stroke with acute middle cerebral artery occlusion based on CT / 中华放射学杂志

Objective:To investigate the predictive value of thrombus enhancement (TE) and thrombus permeability in cardioembolic thrombus with acute middle cerebral artery occlusion based on CT.Methods:The clinical and image data of 93 patients with acute middle cerebral artery occlusion who were admitted to the First Affiliated Hospital of Soochow University within 12 hours after onset from January 2020 to July 2022 were retrospectively analyzed. According to the TOAST criteria, the patients were divided into the cardioembolism (CE) group (43 cases) and the large artery atherosclerosis (LAA) group (50 cases). All patients received noncontrast CT and CT angiography, and then thrombus permeability [thrombus attenuation increase (TAI), void fraction (ε)] and TE were assessed. Independent sample t-test, Mann-Whitney U test and χ2 test were used in univariable analysis between two groups. Multivariable logistic regression analysis was used to explore the independent influencing factors for cardioembolic stroke and establish a logistic model. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive value of TAI, ε, TE and the logistic model in cardioembolic thrombus with acute middle cerebral artery occlusion. Results:There were statistically significant differences in sex, atrial fibrillation, hypertension, diabetes mellitus, smoking, baseline National Institutes of health stroke scale (NIHSS), TAI, ε and TE between the CE group and the LAA group ( P<0.05). Binary logistics regression analysis showed that TAI (OR=1.300, 95%CI 1.147-1.473, P<0.001), hypertension (OR=0.116, 95%CI 0.025-0.535, P=0.006) and baseline NIHSS (OR=1.165, 95%CI 1.040-1.304, P=0.008) were independent influencing factors for cardioembolic thrombus. The ROC curve indicated that the logistic model predicted cardioembolic thrombus with the highest AUC of 0.907 (95%CI 0.848-0.966). TE predicted cardioembolic thrombus with the highest sensitivity of 90.7%. Conclusion:TE and thrombus permeability have application value for predicting cardioembolic thrombus with acute middle cerebral artery occlusion based on CT.

Study on the efficacy and safety of butylphthalide in combination with eureklin in the treatment of patients with acute cardioembolic stroke / 中国药师

Objective To investigate the efficacy and safety of Urinary kallidinogenase(UK)combined with butylphthalide in patients with acute cardioembolic stroke(ACS).Methods A retrospective collection was performed for ACS patients diagnosed and treated in Hangzhou First People's Hospital from May 2022 to April 2023.According to the treatment protocol,ACS patients were divided into UK group and Butylphthalide+UK group.The clinical efficacy,neurological function,serum indexes(Hcy,NT-proBNP and VEGF)and prognosis of the two groups were compared after 2 weeks of treatment.Results A total of 86 ACS patients were included in the study,including 43 in the UK group and 43 in the Butylphthalide+UK group.After treatment,the total effective rate of treatment in the Butylphthalide+UK group was significantly higher than that in the UK group(P<0.05),and there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).In addition,the expression levels of Hcy and NT-proBNP in ACS patients in the Butylphthalide+UK group were significantly lower than those in the UK group(P<0.05),while the expression levels of VEGF were significantly higher than those in the UK group(P<0.05).The NIHSS score and mRS score of ACS patients in the Butylphthalide+UK group were significantly lower than those in the UK group(P<0.05).The rate of collateral circulation establishment in the Butylphthalide+UK group was significantly higher than that in the UK group(P<0.05).Conclusion Butaphthalide combined with UK has significant efficacy and high safety in ACS patients,which may be achieved by regulating the expression levels of serum Hcy,NT-proBNP and VEGF,thereby improving neurological function and promoting the establishment of collateral circulation.

STUDY OF PATIENTS WITH ATRIAL FIBRILLATION IN VIEW OF ETIOLOGICAL EVALUATION AND CLINICAL PROFILE.

Background : Atrial fibrillation(AF) is the most common sustained arrhythmia encountered inclinical practice,accounting 1/3 of hospital-admissions for arrhythmia and rate of admissions for AFhas risen recently.The principle significance of AF both to patient and healthcare system is fivefoldincreased risk of embolic stroke.Methodology: Electrocardiogram confirmed 100 adult(≥18 years) patients of AF were included inthis study and evaluated clinically.Results: Incidence of AF in India is significantly high in younger age group and in Female(58%) ascompared to Western countries,where AF is more common in old age and in Male(42%).Mostcommon cause of AF is Rheumatic heart disease as compared to Western countries,where IHD is thecommonest cause.The average age of patient having RHD developing AF,in India,is 15-20 yearsearlier than patients from Western countries.Most common complication of AF is Congestive cardiacfailure. Most serious complication of AF is Cardio-embolic stroke.Increase in size of Left Atrium inAF is associated with increased risk of Cardio-embolic stroke.Conclusion: Trials have shown reduction in risk,if patients are adequately anticoagulated.so earlyevaluation and prophylactic treatment can reduce mortality and morbidity in patients of AF.

Predictive value of neutrophil/lymphocyte ratio in 90-day risk of death in patients with cardioembolic stroke / 中风与神经疾病杂志

@#Objective　To explore the predictive value of neutrophil/lymphocyte ratio (NLR) on the 90 day mortality risk of patients with cardiogenic cerebral embolism (CE).Methods　245 patients with cardiogenic cerebral embolism were analyzed retrospectively.Demographic data,vascular risk factors,laboratory tests and end point events were collected.The patients were divided into survival group and death group according to whether or not there were end-point events.Multifactor logistic regression was used to analyze the influencing factors of endpoint events,to draw ROC curve,and to evaluate the predictive value of NLR on endpoint events.Results　Of the 245 cases included in the analysis,145 survived and 100 died.Compared with the survivors,the age,hyperlipidemia,atrial fibrillation,mRS score,white blood cell count,glutathione aminotransferase and neutrophil score in the death group were significantly higher (P<0.01),and there was no significant difference in gender,hypertension,diabetes,family history,smoking,alcohol consumption,red blood cell count,hemoglobin and other blood indicators between the two groups(P>0.05).Multivariate logistic regression analysis showed that age,atrial fibrillation,hyperlipidemia and NLR were independent risk factors for 90-day death.ROC shows AUC=0.7558.When the optimal cutoff value of NLR was 5.65,the sensitivity was 68.0%,and the specificity was 76.6%.Conclusion　The increase of NLR at admission is a high risk factor for 90 day death in patients with cardiogenic cerebral infarction,and it has a good predictive value for 90 day death.

Risk factors profile for cardioembolic stroke: A case-control study / Монголын Анагаах Ухаан

Introduction@#In Mongolia, data on the etiology and risk factors of cardioembolic stroke (CES) is scarce and few clinical studies have been performed to date. Timely identification and control of cardiovascular risk factors are priority objectives for adequate primary and secondary prevention of CES.@*Goal@#The goal of this study was to describe risk factors for CES in our setting. @*Results@#The case-control study enrolled a total of 525 subjects. CES was detected in 63 (35.7%) out of 176 (33.5%) ischemic stroke patients with a predominance in age group of 60-69 and men (33%). The main risk factor of CES was non-valvular atrial fibrillation (AF). AF especially paroxysmal AF increased the risk of CES by 4.6 times (p=<0.0001, OR 4.6, 95% CI 1.4-44.6). The second main cerebrovascular risk factors were hypertension and dyslipidemia.@*Conclusion@#CES accounted for 1/3 of ischemic stroke. The commonest underlying medical conditions were non-valvular atrial fibrillation, hypertension, dyslipidemia, alcohol consumption and obesity. Hence, all patients with hypertension and non-valvular AF should be meticulously screened for prevention of CES.

Enfermedad cardioembólica cerebral a partir de un tumor primario de cavidades cardíacas izquierdas / Cerebral cardioembolic disease from a primary tumor of the left heart chambers

Introducción: De los tumores cardiacos primarios, el 75 por ciento son benignos y más de la mitad corresponde a mixomas. Pueden ser asintomáticos o generar manifestaciones cardíacas, sistémicas o embólicas, estas últimas frecuentes. Objetivo: Divulgar la importancia de tener presente el tumor primario cardiaco como causa de enfermedad embólica cerebral. Caso clínico: Hombre de 53 años de edad, con mareos, cefalea, malestar general, decaimiento, dolores articulares, palpitaciones, disnea y ortopnea. Sufrió pérdida de la conciencia y posteriormente pérdida de la fuerza muscular del hemicuerpo izquierdo debido a un accidente vascular encefálico de tipo embólico. Con el ecocardiograma transtorácico, se confirmó el diagnóstico de un tumor primario cardiaco. Después de la operación, se comprobó en anatomía patológica, que era un mixoma. Conclusiones: El mixoma es un tumor que puede producir fenómenos cardioembólicos y se debe tener presente en pacientes como el que se presenta(AU)

Introduction: Of the primary cardiac tumors, 75 percent are benign and more than half correspond to myxomas. They can be asymptomatic or generate cardiac, systemic or embolic manifestations, the latter frequent. Objective: To remark the importance of considering the primary cardiac tumor as a cause of cerebral embolic disease. Clinical case: 53-year-old man with dizziness, headache, general malaise, weakness, joint pain, palpitations, dyspnea and orthopnea. He suffered loss of consciousness and later loss of muscle strength in the left half of the body due to an embolic-type stroke. With the transthoracic echocardiogram, the diagnosis of a primary cardiac tumor was confirmed. After the operation, it was verified in pathological anatomy, that it was a myxoma. Conclusions: Myxoma is a tumor that can produce cardioembolic phenomena and must be taken into account in patients like the one presented(AU)

The impact of intravenous thrombolysis in acute ischemic stroke in National Medical College, Kolkata: initial experience

Background: Acute ischemic stroke is a potentially treatable condition, if left untreated, lead to mortality and morbidity. This study was conducted to study clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (r-TPA-alteplase) and to measure the outcome of thrombolysis.Methods: Retrospective observational study of 54 patients who underwent thrombolysis for acute ischemic stroke at National Medical College, Kolkata over a period of one year.Results: There was statistically significant improvement in NIHSS (p value-0.000) after intravenous thrombolysis.Conclusions: IV thrombolysis is feasible for AIS in governmental hospital in India.

Effect of statin pretreatment on collateral circulation and prognoses of patients with cardiac large artery occlusive stroke / 中华神经医学杂志

Objective To investigate the effect of statin pretreatment on collateral circulation and prognoses of patients with cardiac large artery occlusive stroke.MethodsFifty-three patients with cardiac large artery occlusive stroke admitted to our hospital from January 2016 to July 2019 were selected. All patients had unilateral middle cerebral artery occlusion. DSA was used to evaluate the collateral flows, and the differences of collateral flows and prognoses in patients took statins before onset were compared with those did not take statins.ResultsAs compared with patients did not take statins, patients took statins had higher incidences of diabetes and coronary heart disease, lower content of low density cholesterol, higher proportion of patients with good collateral circulation (grading 3 to 4), and lower modified Rankin scale scores 3 months after surgery, with statistically significant differences (P< 0.05). Multivariate Logistic regression analysis showed that percentage of patients took statins was independent factors affecting collateral flow in patients with cardiac arterial occlusive stroke(OR=5.000, 95％CI: 1.136-22.006,P=0.033).ConclusionIn patients with cardiac large artery occlusive stroke, statin pretreatment could improve collateral flow and clinical prognoses.

Uso de anticoagulantes em pacientes com fibrilação atrial em primeiro evento de AVC e em recidivas / Use of anticoagulants in patients with atrial fibrillation in the first event of AVC and in recidivas

Introdução: A fibrilação atrial (FA) é a causa mais comum de AVC cardioembólico. Esse artigo científico pretende quantificar o número total de pacientes com acidente vascular cerebral cardioembólico portadores de fibrilação atrial prévia, o seguimento do tratamento e a taxa de recorrência. Métodos: estudo retrospectivo (de abril de 2014 a abril de 2015) cujos dados foram extraídos da base JOINVASC e organizados em uma tabela no programa Excel®. Os dados registrados incluíram o total de pacientes que apresentaram AVC cardioembólico inicial ou recorrência de AVC que eram portadores de FA e o uso de medicação anticoagulante ou não. Resultados e conclusões: 49 pacientes com FA conhecida foram encontrados. Desses, 46 receberam anticoagulante após AVC e apenas 3 não receberam tratamento anticoagulante. Entre os pacientes que receberam anticoagulação, 27 usaram varfarina, 3 usaram apixabana, 3 rivaroxabana, 2 dabigatrana e 1 femprocumona. Durante 2 anos, o controle de seguimento foi realizado com os 49 pacientes com FA conhecida, os 3 que não receberam tratamento anticoagulante não sofreram recidiva de AVC ou apresentaram outra comorbidade associada a causas vasculares. Estudo com número maior de sujeitos faz-se necessário para esclarecer o achado de desfecho favorável nos pacientes que não receberam medicação anticoagulante.

Introduction: Atrial fibrillation is the most commonly cause of cardioembolic stroke. This article aim to quantify the total number of patients with cardioembolic stroke that had preview atrial fibrillation, the outcoming of the treatment and if had any recurrence. Methods: It's a retrospective study (April 2014 through April 2015), the data will be registered in a table in the Excel® program, extracted from the data collected from the JOINVASC study of patients who had an initial cardioembolic stroke or recurrence of stroke who had AF and data from the medical record, recording the use or not of anticoagulant and which class. Results and conclusions: In a total of 49 patients with known AF, 46 received anticoagulant after stroke, and only 3 did not receive anticoagulant treatment. Among patients who received anticoagulation, 27 used warfarin, 3 used apixaban, 3 rivaroxaban, 2 dabigatran and 1 phenprocoumon. For 2 years follow-up control was performed with the 49 patients with known AF, the 3 who chose not to receive anticoagulant treatment, after 2 years they had not relapsed or some comorbidity associated with vascular causes. The authors suggest a new study with a larger N, since it can not be affirmed that the non-use is positive.

Síndrome de Foix-Chavany-Marie por infarto biopercular con mecanismo cardioembólico / Foix-Chavany-Marie syndrome sue to biopercular infarction with cardioembolic mechanism

El síndrome de Foix-Chavany-Marie o síndrome biopercular fue descrito como una diplejía labio-facio-faringo-laringo-gloso-masticatoria, con disociación automática del movimiento. Los pacientes que padecen este síndrome presentan alteración del habla (disartria o anartria), disfagia y no pueden abrir la boca, cerrar los párpados o protruir la lengua por voluntad propia, pero pueden sonreír, llorar y bostezar automáticamente. La etiología más frecuente en la edad adulta es la isquémica, a nivel opercular bilateral. Se presenta el caso clínico de un paciente con enfermedad cerebrovascular isquémica de la arteria cerebral media derecha con parálisis pseudobulbar con conversión hemorrágica por mecanismo cardioembólico, con trastorno de la deglución. Tuvo una evolución favorable(AU)

Foix-Chavany-Marie syndrome or biopercular syndrome was described as a lip-facio-pharyngo-laryngeal-glosso-chewing diplegia, with automatic dissociation of movement. Patients with this syndrome have speech impairment (dysarthria or anarthria), dysphagia and cannot open their mouths, close their eyelids or protrude their tongue freely, but they can smile, cry and yawn spontaneously. The most frequent etiology in adulthood is ischemic, at the bilateral opercular level. We report a clinical case of a female patient with ischemic cerebrovascular disease of the right middle cerebral artery with pseudobulbar paralysis, hemorrhagic conversion by cardioembolic mechanism, and swallowing disorder. She evolved favorably(AU)

The value of using B-type natriuretic peptide and D-dimer in preliminary recognition of cardioembolic stroke patients / 实用医学杂志

Objective To determine the value of using B-type natriuretic peptide (BNP) and D-dimer in preliminary recognition of cardioembolic stroke patients.Methods A mutilple-center study was conducted in Foshan Hospital of traditional Chinese Medicine (TCM) and its affiliated hospitals from July 2015 to July 2016.In the emergency departments (EDs),emergency physicians prospectively assessed consecutive adult patients with acute cardioembolic stroke and measured plasma BNP by POCT platform on admission,then followed up.Stroke neurologists evaluated patients' functional outcome at hospital discharge and also made discharge diagnosis and stroke etiologic subtypes according to the TOAST criteria.Results In this study,290 acute ischemic stroke patients met the study criteria [mean age (68.41 ± 12.06) years;53.8％ female].Of the enrolled patients,28.3％ were diagnosed with LAA at discharge,17.9％ with CE,42.8％ with SAO,11.0％ with SOE or SUE.And the mean BNP concentration was significantly higher in the CE group than that in other three subtypes (P ＜ 0.001).After adjustment for multiple clinical predictors like gender,age,coronary artery disease,atrial fibrillation and renal function,BNP and D-dimer were associated with CE [BNP OR:1.044 (95％ CI 1.025,1.064),P ＜ 0.001;D-dimer OR:1.511(95％ CI 1.020,2.238),P =0.039,respectively].Conclusion Through POCT technique in the EDs,cardioembolic stroke patients can be differentiated from other TOAST subtypes.BNP with/without D-dimer has good but different corresponding diagnostic performance in preliminary recognition of cardioembolic stroke patients.

An echocardiographic study in patients with non haemorrhagic cerebral infarction to find cardiac abnormalities.

Background: Strokes are a major cause of morbidity and mortality worldwide. Majority are due to ischemic cerebral infarction. Ischemia may result from occlusion of blood vessels due to a disease process intrinsic to carotid and intracranial vessels or may relate to coexisting heart diseases, predisposing to embolic phenomenon. Objective: Echocardiographic study in patients with cerebrovascular accident, confirmed to be of non hemorrhagic nature on CT scan/MRI, for evidence of potential cardiac abnormalities as a predisposing cause for the vascular event. Material and Methods: An observational study was conducted in department of medicine, GNDH, Amritsar. 50 patients of ischemic stroke were taken and 2D transthoracic echocardiography was done to find potential cardioembolic abnormalities. Results: 76% of patients had echocardiographic abnormalities and 42% had potential cardioembolic abnormalities, out of which most common were ventricular wall hypokinesia, calcific aortic valve, rheumatic heart disease and dilated cardiomyopathy. The prevalence was almost similar in different age groups and both the sexes. Conclusion: Prevalence of potential cardioembolic abnormalities is high (42%) in ischemic stroke patients and 2D echocardiography is therefore recommended in the management and secondary prevention of cardioembolic stroke, which has a higher mortality and more chances of recurrence than atherothrombotic type of ischemic stroke.

Score for atrial fibrillation detection in acute stroke and transient ischemic attack patients in a Brazilian population: The acute stroke atrial fibrillation scoring system

OBJECTIVE: Atrial fibrillation is a common arrhythmia that increases the risk of stroke by four- to five-fold. We aimed to establish a profile of patients with atrial fibrillation from a population of patients admitted with acute ischemic stroke or transient ischemic attack using clinical and echocardiographic findings. METHODS: We evaluated patients consecutively admitted to a tertiary hospital with acute ischemic stroke or transient ischemic attack. Subjects were divided into an original set (admissions from May 2009 to October 2010) and a validation set (admissions from November 2010 to April 2013). The study was designed as a cohort, with clinical and echocardiographic findings compared between patients with and without atrial fibrillation. A multivariable model was built, and independent predictive factors were used to produce a predictive grading score for atrial fibrillation (Acute Stroke AF Score-ASAS). RESULTS: A total of 257 patients were evaluated from May 2009 to October 2010 and included in the original set. Atrial fibrillation was diagnosed in 17.5% of these patients. Significant predictors of atrial fibrillation in the multivariate analysis included age, National Institutes of Health Stroke Scores, and the presence of left atrial enlargement. These predictors were used in the final logistic model. For this model, the area under the receiver operating characteristic curve was 0.79. The score derived from the logistic regression analysis was The model developed from the original data set was then applied to the validation data set, showing the preserved discriminatory ability of the model (c statistic = 0.76). CONCLUSIONS: Our risk score suggests that the individual risk for atrial fibrillation in patients with acute ischemic stroke can be assessed using simple data, including age, National Institutes of Health Stroke Scores at admission, and the presence of left atrial enlargement. .

Practical Issues to Prevent Stroke Associated with Non-valvular Atrial Fibrillation / 대한뇌졸중학회지

Stroke associated with non-valvular atrial fibrillation (NVAF) is one of the most important subtypes of ischemic stroke, and its importance is becoming even more apparent in an aging population. To assess the risk of stroke associated with NVAF, the CHADS2 and CHA2DS2-VASc scores are mainly used. Such scores can be used to predict the recurrence and prognosis of ischemic stroke. In addition, new oral anticoagulants (NOACs) and devices are being evaluated in the prevention of stroke associated with NVAF in addition to treatment with the conventional oral anticoagulant, warfarin. Since clinical experience with NOACs is not globally sufficient, a cautious approach is needed.

The clinical significance of testing plasma brain natriuretic peptide(BNP) in cardioembolic stroke patients / 中国基层医药

Objective To study the relationship between cardioembolic stroke and plasma BNP by analyzing the plasma BNP level in cardioembolic stroke patients.Methods The clinical data of 81 patients with acute stroke were collected.According to the TOAST classification,all the patients were diagnosed as non-cardioembolic stroke,including atherothrombotic,lacunar,others etiology and undetermined etiology cardioembolic stroke.Blood samples were drawn on emergency department arrival( within 24 hours) to test BNP( assayed by ELISA).The plasma BNP level between non-cardioembolic stroke and cardioembolic stroke was compared.Results Cardiogenic stroke patients with plasma BNP level( 147.5 ±7.8 ) ng/L,atherosclerotic stroke patients level(51.2 ± 5.8) ng/L,lacunar stroke( 39.5 ±10.0)ng/L.Higher levels of BNP were observed in patients with cardioembolic stroke than other stroke subtypes(t =67.8,23.6,17.6,all P ＜ 0.01 ).Conclusion The plasma BNP could be used for distinguishing cardioembolic stroke from other stroke subtypes and has great clinical significance in etiologic diagnosis of ischemic stroke subtypes.

Immediate Anticoagulation for Acute Cardioembolic Stroke is Still Popular in Selective Cases in Korea / 대한뇌졸중학회지

BACKGROUND: Although current guidelines do not recommend immediate anticoagulation therapy (IAC) for acute ischemic stroke, judicious debates are still lingering on whether it might be done for acute cardioembolic stroke (ACES). We surveyed current practice patterns of anticoagulation therapy for ACES in Korea, and analyzed their related factors. METHODS: Using a web-based system, all neurology staffs of training hospitals in Korea surveyed about when and how they commenced anticoagulation therapy in the hypothetical cases with ACES. RESULTS: Of the 359 subjects invited, 281 responded to the e-mail, of whom 76 abstained from participating. The number of participants was therefore 205 (57.1%). Although a few physicians (4.4%) always performed IAC and some (10.7%) never did, most physicians made different decisions according to infarct size and presence of hemorrhagic transformation (HTr): IAC was performed more often in cases with medium-sized or small infarct than large one (68.2% vs. 35.9%, P<0.001), and in cases without HTr (68.6% vs. 34.9%, P<0.001). The most common method of administration was 'heparin followed by warfarin' (68.2%), and then 'warfarin alone' or 'warfarin with aspirin'. If IAC was not commenced, it resumed most commonly between 1 and 2 weeks after the onset (44.0%). CONCLUSION: Quite many neurologists in Korea did IAC in selective ACES, e.g. small sized infarction without HTr. Further studies are needed to prove the efficacy of IAC therapy in this selective population.

Cardiomiopatía periparto temprana complicada con accidente cerebrovascular cardioembólico: a propósito de un caso / Early peripartum cardiomyopathy complicated by cardioembolic stroke: a case report

Presentamos el caso de una paciente con cardiomiopatía periparto quien súbitamente presentó hemiplejia flácida, producido por un accidente cerebrovascular de origen cardioembólico con transformación hemorrágica en la evolución. El diagnóstico fue clínico, ecocardiográfico y tomográfico. La evolución del cuadro neurológico fue favorable, con recuperación parcial de la funcionalidad. Se presenta este caso debido a la presentación atípica de una nosología infrecuente: "la cardiomiopatía periparto", cuyas complicaciones suscitaron controversias en el manejo terapéutico.

We report a case of a patient with peripartum cardiomyopathy, who suddenly suffered left hemiplejia. The neurological status was the result of Cardioembolic Stroke which transformed from ischemic to hemorrhagic in evolution. The diagnosis was based on the clinical, echocardiographical and tomographical findings. The evolution of the neurological status improved, nevertheless the cardiac and neurologic disease recovery almost completely. We present this case due the atypical presentation of peripartum cardiomyopathy in this patient, and the neurological complication that generated controversies in its management.

The Findings of Transesophageal Echocardiography in the Evaluation of the Source of Ischemic Stroke

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.