Cardioembolic Stroke in Young Patients – A Prospective Analysis

ABSTRACT

Introduction: One in six ischemic strokes is caused bycardiogenic embolism. The current knowledge regardingthe natural history, diagnosis, prevention, and treatment ofcardioembolic stroke is reviewed in this study. Nonrheumaticatrial fibrillation is the most frequent substrate for brainembolism and patients with this dysrhythmia have a fivefoldincrease in the risk of stroke. Study aimed to evaluate theclinical assessment of the patients with ischemic stroke lessthan 45 years of age.Material and Methods: 50 patients who were admitted inthe medical and neurology wards of Govt. Stanley medicalcollege, Chennai during the study period from December 2003to May 2004 for ischaemic stroke were clinically examined.The inclusion and exclusion criteria were satisfied, resultswere clinically and statistically assessed and the relevance oftransthoracic echocardiography was studied in them.Results: Cardiogenic embolism mostly affects the malepopulation more frequently and the most commonly affectedage group is 30-45 years. The clinically identifiable cardiaclesion was present in 77% of the cases. The most commondisease is rheumatic valvular disease as seen in about 5 casesfollowed by ischemic heart disease which was found in about3 cases. Abnormal ECG findings were observed in 12% ofcases in the form of atrial fibrillation. Left atrial enlargement,old infarct changes, conduction abnormality and recurrentstroke(12%) were the other findings. In these, 66% (4 cases)were due to the cardioembolic origin. The echocardiographicstudy increases the sensitivity of detecting cardiac lesion by22%.Conclusion: Cardiac lesion accounts for 36% of brainembolism. Hemiparesis is the most common presentation(88% of cases) followed by Hemiplegia. The middle cerebralartery is most commonly affected by embolism. Rheumaticheart disease (39%) and Ischemic heart disease are theimportant causes of brain embolism in this study.