[Thrombotic or embolic stroke?]

Transoesophageal echocardiography reveals a possible source of embolism in many patients who present with acute brain ischaemia. The aim of this study was to observe the prevalence of possible sources of embolism in a representative Norwegian stroke population in a county hospital with a defined reference population.

All 103 patients with ischaemic stroke or transient ischaemic attack admitted to our hospital during a five-month period were enrolled. We performed transthoracic echocardiography in 98 patients, transoesophageal echocardiography in 83, and Doppler examination of the precerebral arteries in 92.

Mean patient age was 72 years; 19 patients had atrial fibrillation. Examinations revealed 70 potential sources of embolism in 55 patients. Twenty-eight findings were in the heart. Five patients had thrombi in left-sided heart chambers. Ten patients had patent foramen ovale; 11 had atrial septal aneurysm; four had both. Thirty-three had atheromas of the aorta with a protrusion of more than 4 mm, ten of them with mobile elements. Nine patients had carotid stenosis of high grade or carotid occlusion ipsilateral to a hemispheric stroke.

Potential precerebral sources of embolism are common in a representative population of patients with ischaemic stroke. Atheromas of the aorta may be an important contributor to brain ischaemia.