Neurologists' perspective in the evaluation of ischemic stroke

The evaluation of victims of ischemic stroke has evolved over the last few years, primarily as a result of the introduction of innovative, sensitive, and informative diagnostic procedures. The role of the neurologist appears to have been redefined as one in which the identification of the presumptive cause and mechanism of the stroke is one of the primary responsibilities. The trend towards classification of patients into stroke subtypes, based upon etiology and pathogenesis, has led to a shift in care to a more etiology-specific approach. The inclusion of results of ancillary tests in the criteria utilized for stroke subtype classification has expanded the neurologists' ability to ascertain the presumptive etiology of many strokes that in the past were considered of unknown etiology. This has also resulted in an apparent increase in the proportion of ischemic strokes presumably due to cardiogenic embolism. The impact of transesophageal echocardiography upon changes in the presumptive etiology of ischemic stroke is illustrated, underscoring the future collaboration of neurologists and cardiologists in the evaluation of victims of presumed cardiogenic ischemic stroke.