[Cerebral ischemic events: when and how to look for a cardiac embolism source?]

In industrialized countries, cerebral ischemic events rank third among the most frequent causes of death. In survivors, long-term disability may result. The diagnosis and therapy of preventable causes is therefore a major task. Echocardiography has proven to be most helpful in the search for cardioembolic sources, and the transesophageal approach (TEE) is superior to the transthoracic (TTE) in this specific indication. In patients in whom a cardioembolic source can be identified by clinical examination, 12-lead surface ECG or chest X-ray, an additional echocardiographic examination is not necessary. Patients under 50 with cerebral ischemic events should undergo TEE. In patients over 70 with a contraindication for long-term anticoagulant therapy, TEE has no therapeutic consequences and should therefore not be performed. In patients aged between 50 and 70 the diagnostic procedure of choice must be considered in each individual patient. It should be kept in mind that a more aggressive approach using TEE, from which therapeutic conclusions are drawn, has not clearly been shown to improve the prognosis of patients with cerebral ischemic events.