ABSTRACT
BACKGROUND AND PURPOSE: Stroke is the third leading cause of death in most Western countries. Cardioembolism might be responsible for 15% to 20% of ischemic strokes. Although atrial fibrillation can be diagnosed by electrocardiography, the remaining causes of cardioembolic stroke are diagnosed by echocardiography. Recent recommendations on the management of acute ischemic stroke fail to consider echocardiography as an essential test in all patients. METHODS: We conducted a prospective observational study, performing transthoracic echocardiography on all patients admitted in our hospital with ischemic stroke, in sinus rhythm, from January 7, 2002, to October 16, 2003. Findings compatible with heart diseases that would indicate anticoagulation as beneficial were identified. RESULTS: Of the 853 patients admitted with ischemic stroke, transthoracic echocardiography was performed on 846 (99.2%). Of the 435 patients with ischemic stroke, in sinus rhythm, 37.2% had findings indicating anticoagulation as beneficial: dilated cardiopathy (19.1%), previous anterior wall myocardial infarction (6.2%), left ventricular systolic dysfunction with an ejection fraction <35% (3.7%), mitral valve stenosis with enlarged left atria (1.6%), intracardiac masses (0.5%), valvular prosthesis (0.2%), and >1 abnormality (5.5%). CONCLUSIONS: In our study, transthoracic echocardiography had therapy implications in 37.2% of ischemic stroke patients in sinus rhythm. Transthoracic echocardiography should be considered an essential test in all ischemic stroke patients in sinus rhythm.
Subject(s)
Echocardiography/methods , Embolism/diagnosis , Embolism/therapy , Myocardial Ischemia/diagnosis , Myocardial Ischemia/therapy , Stroke/diagnosis , Stroke/therapy , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Atrial Fibrillation , Cardiomyopathy, Dilated/diagnosis , Female , Heart Atria/abnormalities , Heart Valve Prosthesis , Humans , Ischemia/pathology , Male , Middle Aged , Mitral Valve Stenosis/diagnosis , Myocardial Infarction/diagnosis , Stroke Volume , Systole , Ventricular Dysfunction, Left/diagnosisABSTRACT
BACKGROUND: Periodic fever can have one of multiple causes. Among the hereditary periodic fever syndromes, hyper-IgD syndrome (HIDS) is a possible diagnosis, although, until now, no cases had been described in Portugal. CASE-REPORT: We report a 25-year-old woman, with periodic fever since she was 8 months old. She had high serum IgD levels, and a molecular study of the mevalonate kinase gene was performed. A compound heterozygote was found for two mutations: V377I and T237S. This last mutation had not been observed before. DISCUSSION: We analyse the clinical features that made us think on HIDS as a possible diagnosis, and we highlight the features that are important for the differential diagnosis between HIDS and other periodic fevers. CONCLUSIONS: HIDS is a possible diagnosis for patients with periodic fever, even in Portugal.
