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Cardiac embolism: the neurologist's perspective
1Department of Medicine-Neurology, University of Texas Health Sciences Center, San Antonio 78284.
Insights
Cardioembolic stroke is a significant health issue. This study offers a management algorithm to reduce stroke recurrence and brain hemorrhage risks.
Area of Science:
- Neurology
- Cardiology
Background:
- Cardioembolic stroke presents a major healthcare challenge in the U.S., causing significant morbidity, mortality, and costs.
- Diagnosing stroke etiology is complex due to multiple potential causes and insensitive diagnostic tools.
Purpose of the Study:
- To outline diagnostic clues for cardioembolic stroke.
- To present a management algorithm for acute cardioembolic stroke.
Main Methods:
- Review of clinical and laboratory clues for diagnosis.
- Utilization of computed tomography (CT) scans and cerebral angiograms.
- Consideration of echocardiography for selected patients.
- Development of a management algorithm balancing anticoagulation benefits against hemorrhage risks.
Main Results:
- Computed tomography scans, especially at 48 hours, are essential for identifying hemorrhagic infarctions.
- Cerebral angiograms can be helpful if performed early.
- Echocardiography is reserved for patients with a higher likelihood of cardiac abnormalities.
Conclusions:
- A structured approach to diagnosis and management is crucial for cardioembolic stroke.
- The proposed algorithm aims to minimize both stroke recurrence and the risk of symptomatic brain hemorrhage.
Abstract:
Cardioembolic stroke represents a major healthcare challenge in the United States, accounting for significant morbidity and mortality, as well as economic and social costs. Determining the cause of ischemic stroke is often difficult because multiple potential etiologies are often present and available diagnostic tools are relatively insensitive. The diagnosis of cardioembolic stroke is based on a variety of clinical and laboratory clues that are significant, although not invariable, predictors of stroke etiology. Computed tomography scans help suggest etiology, and scans performed at 48 hours after stroke onset are essential to identify hemorrhagic infarctions. Cerebral angiograms may be helpful if performed early. Echocardiography is indicated only for selected patients who are more likely to demonstrate cardiac abnormalities on an echocardiogram. The management of acute cardioembolic stroke involves weighing the benefits of reducing stroke recurrence by anticoagulation against the risk of symptomatic brain hemorrhage. A management algorithm is provided that can help reduce both the risk of symptomatic brain hemorrhage and the incidence of potentially disabling stroke recurrence.