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How often can an embolic stroke be diagnosed clinically? A clinicopathological correlation
Insights
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.
Abstract:
A retrospective case note survey of 103 autopsy proven cases of cerebral infarction was carried out to assess how often a cardiac source for embolism had been correctly suspected on clinical grounds. Only 61% of 46 patients with cardiac embolic sources were so identified. Cases of rheumatic heart disease and bacterial endocarditis were more frequently identified than cases of mural thromboembolism from ischaemic heart disease. This relative failure of unaided clinical diagnostic criteria probably accounts for the discrepancy between the autopsy evidence of cardiac embolism as a cause of stroke (about 40%), and clinical studies (about 20%).