Brain embolism - Answers to practical questions.

Area of Science:

• Neurology
• Cardiology
• Medical Imaging

Background:

• Cardioembolism constitutes approximately 25% of ischemic strokes, often leading to severe outcomes and high recurrence rates.
• Identifying the precise source of cardioembolic stroke can be challenging despite clinical suspicion.
• Non-valvular atrial fibrillation is the most frequent cause of cardioembolic stroke, with aortic arch atheroma emerging as a significant source.

Purpose of the Study:

• To review the diagnostic modalities for identifying cardioembolic stroke sources.
• To discuss the clinical implications and management strategies for cardioembolic stroke.
• To highlight the underutilization of oral anticoagulation in patients with atrial fibrillation.

Main Methods:

• Review of diagnostic tools including magnetic resonance imaging (MRI), transcranial Doppler (TCD), echocardiography, Holter monitoring, and electrophysiological studies.
• Analysis of embolic risk factors such as non-valvular atrial fibrillation and aortic arch atheroma.
• Evaluation of treatment guidelines regarding anticoagulation for acute cardioembolic stroke and atrial fibrillation.

Main Results:

• Various imaging and electrophysiological studies aid in documenting cardioembolic sources.
• Non-valvular atrial fibrillation is the predominant cause, yet oral anticoagulation is underprescribed in at-risk patients.
• Patent foramen ovale carries a low embolic risk unless associated with atrial septal aneurysm.

Conclusions:

• Accurate documentation of cardioembolic stroke sources relies on a combination of advanced diagnostic techniques.
• There is a significant gap in the prescription of oral anticoagulation for patients with atrial fibrillation.
• Routine immediate anticoagulation for acute cardioembolic stroke is not supported by current evidence.