[Analysis of the echocardiographic findings in young patients with cerebral ischemia]

When we consider the importance of cardioembolism in the aetiology of cerebral ischaemia in young adults, echocardiography, both transthoracic and transesophageal, becomes of increasing diagnosis importance. We analyze its usefulness and contribution to the reduction in the number of cerebral ischemias of unknown origin.

We selected persons aged between 14 and 45 years who had had cerebral ischaemia during the period between January 1991 and April 1998. The protocol for the diagnosis of stroke in young persons was applied to all of them together with transthoracic echocardiography whenever there was the possibility of embologenous cardiopathy followed by transesophageal echocardiography when the transthoracic echocardiography was not diagnostic.

In 114 identified cases, 98 transthoracic echocardiographs were done, of which 14 were diagnostic, together with 32 transesophagic echocardiograms, which showed nine cases of embologenous cardiopathy not detected on transthoracic echography. The most frequent diagnoses were: prolapsed mitral valve (14); patent foramen ovale (8); mitral stenosis (5) and interauricular septal aneurysm (4). A total of 31 patients were diagnosed as having a previously unrecognized cardioembolic origin of their illness.

The diagnostic usefulness of transthoracic echography was 22.45% (9.18% were false negatives), and 28.12% for transesophagic echocardiography. These reduced the diagnosis of ischaemia of unknown origin by 32.69% and 20% respectively. Besides, in 75% of the patients with a patent foramen ovale and 100% of those with interauricular septal aneurysms, no other possible cause for their condition was found. Transthoracic echocardiography is a technique to be recommended in all cases of cerebral ischaemia of unknown origin in young adults. Its usefulness may be enhanced by transesophagic ultrasonography when diagnosis cannot be definitely made on transthoracic echosonography alone.