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Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: neurologic examination
S J Kittner1, C M Sharkness, M A Sloan
1Department of Neurology, University of Maryland, Baltimore.
Insights
Neurologic signs like altered consciousness and cortical deficits can indicate a stroke from a cardiac embolism. However, even significant findings have low predictive value for identifying an embolic source.
Area of Science:
- Neurology
- Cardiology
- Stroke Medicine
Background:
- Cardiogenic embolism is a significant cause of ischemic stroke.
- Identifying the source of cerebral infarcts is crucial for effective treatment and prevention.
Purpose of the Study:
- To investigate the association between specific neurologic deficits and the risk of stroke due to cardiogenic embolism.
- To evaluate the diagnostic utility of neurologic signs in identifying cardiac sources of embolism.
Main Methods:
- Analysis of data from 1,290 patients with cerebral infarcts from the NINDS Stroke Data Bank.
- Patients categorized into high, medium, and low risk groups based on potential cardiac sources of embolism.
- Assessment of neurologic signs including level of consciousness, visual field abnormalities, neglect, aphasia, and hemiparesis.
Main Results:
- Diminished level of consciousness showed a high association with cardiac sources of embolism.
- Cortical deficits (visual field abnormalities, neglect, aphasia) demonstrated a graded relationship with cardiac risk.
- Hemiparesis without sensory or cortical deficits was inversely associated with cardiogenic embolism risk.
- The predictive value of these neurologic findings for an embolic source was generally low.
Conclusions:
- While certain neurologic signs are associated with cardiogenic embolism, they have limited predictive power.
- Clinical assessment of neurologic deficits can provide clues but requires integration with other diagnostic tools.
- Further research is needed to improve the identification of cardiogenic stroke mechanisms.
Abstract:
To gain insight into neurologic signs relevant to the diagnosis of cardiogenic embolism, we analyzed data from 1,290 patients with cerebral infarcts in the NINDS Stroke Data Bank. Based solely on the presence of potential cardiac sources of embolism, we divided patients into groups of high (N = 250), medium (N = 167), and low (N = 873) risk of a cardiogenic mechanism for their stroke. Diminished level of consciousness was highly associated with the presence of a cardiac source of embolism. Of the four primarily cortical deficits assessed, three (visual field abnormalities, neglect, and aphasia) showed a highly significant graded relationship to the cardiac risk groups. For the fourth cortical deficit (other nonlanguage cognitive functions), this relationship did not attain statistical significance. Conversely, hemiparesis without sensory or cortical deficits had a strong inverse association to the presence of a cardiac source of embolism. This inverse association was weaker for sensorimotor strokes and nonexistent for pure sensory strokes. Although some neurologic findings had highly significant associations with the presence of a cardiac source of embolism, their predictive value for an embolic source was low.