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How often can an embolic stroke be diagnosed clinically? A clinicopathological correlation
Postgraduate Medical Journal
|December 1, 1985
Summary
Clinical suspicion of cardiac embolism as a cause of cerebral infarction is often missed. Autopsy data reveals a higher incidence of cardiac sources for stroke than clinical assessments suggest.
Area of Science:
- Neurology
- Cardiology
- Pathology
Background:
- Cerebral infarction, a leading cause of stroke, can result from cardiac embolism.
- Clinical diagnosis of cardiac sources for embolism is challenging.
Purpose of the Study:
- To evaluate the accuracy of clinical suspicion for cardiac embolism in autopsy-proven cerebral infarction cases.
- To identify discrepancies between clinical and autopsy findings regarding cardiac causes of stroke.
Main Methods:
- Retrospective survey of 103 autopsy cases with cerebral infarction.
- Analysis of clinical case notes to assess suspicion of cardiac embolic sources.
Main Results:
- Only 61% of patients with confirmed cardiac embolic sources were correctly identified clinically.
- Rheumatic heart disease and bacterial endocarditis were more readily suspected than mural thromboembolism from ischemic heart disease.
- Autopsy indicated cardiac embolism as a cause in ~40% of strokes, contrasting with ~20% in clinical studies.
Conclusions:
- Clinical diagnostic criteria often underestimate the role of cardiac embolism in cerebral infarction.
- Improved clinical suspicion and diagnostic approaches are needed to bridge the gap between autopsy findings and clinical assessments of stroke etiology.