Clinical and Cardiovascular Magnetic Resonance Findings in Endurance Athletes With Symptomatic Stroke

Stroke in athletes is believed to be rare given fewer traditional stroke risk factors in this population, although there is a distinct lack of data. We present a case series of 6 veteran endurance athletes who experienced symptomatic strokes and underwent cardiovascular magnetic resonance imaging.

Underlying causes of the stroke were established in 5 athletes: atrial fibrillation (n = 2), likely apical hypertrophic cardiomyopathy with thrombus, patent foramen ovale, and carotid artery dissection. Nonischemic myocardial fibrosis was highly prevalent, while exercise-induced hypertension was present in approximately half of the cases.

Our findings illustrate a range of etiologies causing stroke in athletes. They also highlight weaknesses with stroke risk-stratification methods in athletes with atrial fibrillation, along with possible modifiable risk factors including masked hypertension and exercise-induced hypertension. Our cases highlight the role of cardiovascular magnetic resonance in detecting the etiology of stroke and propose myocardial fibrosis as a potential novel marker of stroke risk in veteran endurance athletes.