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Is TEE useful in patients with small subcortical strokes?
A A Rabinstein1, J A Chirinos, F R Fernandez
1Department of Neurology, Cerebrovascular Division, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL 33101, USA. arabinstein@med.miami.edu
European Journal of Neurology
|May 26, 2006
Summary
Transesophageal echocardiography (TEE) is valuable for stroke investigation. However, in patients with lacunar stroke, combining clinical lacunar syndrome with radiological infarcts on CT reliably predicts a negative TEE, ruling out cardioaortic embolism.
Area of Science:
- Neurology
- Cardiology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is established for stroke mechanism investigation.
- Its utility in lacunar stroke presentations remains uncertain.
- Basic work-up including carotid ultrasound and transthoracic echocardiography is often non-diagnostic.
Purpose of the Study:
- To evaluate the predictive value of lacunar syndrome and radiological findings for TEE results in acute cerebral ischemia.
- To determine if specific clinical and radiological features can predict a negative TEE, excluding cardioaortic embolism.
Main Methods:
- Retrospective review of 214 patients with acute cerebral ischemia undergoing TEE.
- TEE considered positive for cardioaortic sources: aortic plaques, atrial thrombus, valve vegetations, or patent foramen ovale with atrial septal aneurysm.
- Multivariate regression analysis to assess predictors of TEE results, including lacunar syndrome and small subcortical infarcts on CT.
Main Results:
- Fifty-two patients (24%) had positive TEE findings.
- Large or complex aortic plaques were the most common source (19%).
- Neither lacunar syndrome nor small subcortical infarcts alone predicted TEE results.
- The combination of lacunar syndrome and radiological small subcortical infarction predicted a negative TEE with 100% negative predictive value (P=0.01).
Conclusions:
- The combination of lacunar syndrome and radiological small subcortical infarction is a strong predictor of the absence of cardioaortic embolism on TEE.
- This finding can help refine the diagnostic approach in patients with acute cerebral ischemia presenting with lacunar features.
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