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[Ischemic cerebrovascular seizure: when and how should one search for a cardiac embolism source?]
M Peter1, P Rickenbacher, D Burckhardt
1Abteilung für Kardiologie, Kantonsspital, Basel.
Insights
Cardiac embolism causes 15-20% of ischemic strokes, often linked to atrial fibrillation. Echocardiography aids diagnosis for other cardiac sources, but transesophageal echocardiography is reserved for specific cases.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Context:
- Cerebral embolism represents a significant cause of ischemic stroke, accounting for 15-20% of cases.
- Cardiac sources are a primary origin for cerebral emboli, necessitating accurate diagnostic approaches.
Purpose:
- To delineate the diagnostic strategies for identifying cardiac sources of cerebral embolism.
- To clarify the indications for echocardiography and transesophageal echocardiography in stroke evaluation.
Summary:
- Atrial fibrillation is the most frequent cardiac source of embolism, warranting immediate anticoagulation without further diagnostic imaging.
- Emboli from the left ventricle and valves often present with clinical signs, supporting echocardiography for diagnosis.
- Left atrial embolism is rare and typically requires transesophageal echocardiography for detection, particularly in younger patients without apparent cardiac disease.
Impact:
- This guidance aids clinicians in selecting appropriate diagnostic tools for stroke patients with suspected cardiac embolism.
- Optimizing diagnostic pathways can lead to timely and effective treatment, potentially reducing stroke-related morbidity and mortality.
Abstract:
Cerebral embolism originating from the heart accounts for approximately 15 to 20% of ischemic strokes. By far the most important source for cardiac embolism is associated with atrial fibrillation; in these patients immediate anticoagulation with no further echocardiographic diagnostic is recommended. The majority of the remaining cardiac sources of embolism--they originate from the left ventricle and the valves--can be suggested by clinical signs. In these cases a documentation by echocardiography is indicated. In contrast, embolism originating from the left atrium is rare and commonly not detectable by simple clinical means. The semi-invasive transesophageal echocardiography is able to visualize atrial pathologies with a high accuracy, but this investigation should be performed routinely only in patients less than 45 years old with no evidence for cardiac disease.