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Distribution of ischemic cerebrovascular events in cardiac embolism
W Oder1, P Siostrzonek, W Lang
1Universitätsklinik für Neurologie, Universität Wien, Osterreich.
Insights
Cardiac embolism is a significant cause of ischemic cerebrovascular events, affecting various brain territories. Early cardiac assessment is crucial, especially for recurrent events in specific circulations.
Area of Science:
- Neurology
- Cardiology
- Vascular Surgery
Background:
- Cerebral ischemia can stem from cardiac embolism or craniocervical vessel ulcerations.
- Distinguishing between these sources is vital for effective patient management.
Purpose of the Study:
- To compare the distribution and frequency of ischemic cerebrovascular events in patients with cardiac embolism versus those with craniocervical vessel ulcerations.
- To identify any distinct patterns in affected vascular territories.
Main Methods:
- Retrospective study of 57 patients with cardiac embolism and 39 with craniocervical vessel ulcerations.
- Exclusion of patients with coexisting lesions.
- Analysis of lesion localization and recurrence patterns.
Main Results:
- No significant difference in lesion localization between cardiac embolism and craniocervical vessel ulcerations.
- Commonly affected territories: left middle cerebral artery (42.9%), right middle cerebral artery (23.8%), vertebrobasilar (19%), ophthalmic arteries (14.2%).
- High frequency of recurrent cardiogenic emboli in ophthalmic and vertebrobasilar territories, often with delayed cardiac assessment.
Conclusions:
- Cardiac embolism should be considered in all patients with cerebral ischemia, regardless of the affected vascular territory.
- Delayed cardiac assessment in patients with recurrent emboli to specific territories highlights a potential diagnostic gap.
- Further research into early detection and management strategies for cardiogenic stroke is warranted.
Abstract:
Distribution and number of ischemic cerebrovascular events were studied in 57 patients who suffered from heart disorders with proven or highly probable source of cardiac embolism and compared to 39 patients with ulcerations of the craniocervical vessels. Patients with coexisting lesions were excluded from the present study. Out of the 57 patients with cardiac disorders, a single episode of cerebral embolism occurred in 33 patients. Of the 24 patients with recurrent ischemic episodes, different vascular territories were involved in only six cases. There was no evidence of a distinct distribution of vascular territories involved in cerebral embolism. The left middle cerebral artery was affected in 42.9%, the right middle cerebral artery in 23.8%, the vertebrobasilar territory in 19%, and the ophthalmic arteries in 14.2%. Statistical analysis revealed no significant differences in lesion localization between the group with a cardiac source of embolism and the group with ulcerations of the craniocervical vessels. There was a high frequency of patients with recurrent cardiogenic emboli in the ophthalmic (6 of 9 patients) as well as in the vertebrobasilar (6 of 12 patients) circulation who experienced a delayed initiation of cardiac assessment. The possibility of cardiac embolism should be considered in any patient with cerebral ischemia, independently of the vascular territory affected.