Specific cardiological evaluation after focal cerebral ischemia

Area of Science:

• Neurology
• Cardiology
• Diagnostic Imaging

Background:

• Acute focal brain ischemia, including transient ischemic attack (TIA) and stroke, presents diagnostic challenges.
• Identifying the source of embolism is crucial for effective treatment and secondary prevention.
• Cardiogenic sources are a significant, yet sometimes elusive, cause of brain embolism.

Purpose of the Study:

• To define a specific subgroup of TIA/stroke patients who would benefit from transthoracic and transesophageal echocardiography or Holter-electrocardiography.
• To reliably identify patients with cardiogenic brain embolism.

Main Methods:

• A standardized diagnostic protocol was applied to 300 consecutive patients with acute focal brain ischemia.
• Evaluations included clinical examination by a cardiologist, routine ECG, Holter-ECG, transthoracic echocardiography, and transesophageal echocardiography.
• Etiological evaluation focused on identifying potential cardiac sources of embolism.

Main Results:

• Out of 300 patients, 188 had a potential cardiac source of embolism.
• Echocardiography identified a source in 163 patients; Holter-ECG identified a source in 10 patients.
• Cardiogenic brain embolism was considered definite or possible in 136 patients, with 84.6% having competing etiologies like atherosclerosis.

Conclusions:

• Transthoracic and transesophageal echocardiography are essential for diagnosing cardiogenic brain embolism in 89% of patients with specific clinical or ECG findings.
• Holter-electrocardiography is indicated in 54% of these patients.
• Targeted use of these diagnostic tools can reliably identify patients with cardiogenic brain embolism.