Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke.

Primary malignant cardiac tumors (cardiac angiosarcomas) are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT) scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.

Etiology, duration, and prognosis of transient ischemic attacks: an analysis from the German Stroke Data Bank.

CONTEXT: A transient ischemic attack (TIA) has been arbitrarily defined as a focal cerebral ischemic deficit lasting less than 24 hours. OBJECTIVE: To determine if TIAs of short duration (<1 hour) and long duration (1 hour to <24 hours) differ from each other and from ischemic stroke (IS). DESIGN, SETTING, AND PATIENTS: Inception cohorts of 1429 patients with acute TIAs and 5206 patients with IS were prospectively documented in 15 German medical centers with neurology departments and acute stroke units. Outcome after 3 months was assessed in 72.8% of the patients with TIAs. MAIN OUTCOME MEASURES: Risk factor distribution, etiology, and prognosis of TIAs and IS. RESULTS: Patients with TIAs, especially those with symptoms lasting less than 1 hour, were significantly more likely to have a history of TIAs and less likely to have diabetes mellitus, arterial hypertension, or atrial fibrillation at admission compared with those with IS. Cardioembolic etiologies were less frequent and unknown etiologies more frequent among patients with TIAs than those with IS. Functional outcome and mortality did not differ significantly in patients with TIAs of different durations. CONCLUSION: This study demonstrates differences in comorbidity and etiology among patients with TIAs of different durations and IS.