Cerebral microembolism in patients with stroke or transient ischaemic attack as a risk factor for early recurrence

The incidence of early recurrence in 32 patients who had had a transient ischaemic attack or stroke in the anterior circulation was studied. Patients with a potential cardiac source of embolism were excluded from the study. All patients had transcranial Doppler (TCD) monitoring of the symptomatic middle cerebral artery for microembolic signal detection within seven days from the onset of symptoms. Four patients had early recurrence during a mean follow up of 15 (SD11) days. All early recurrences occurred in the same arterial territory as the initial ischaemic event. Three of the four patients with early recurrence had prior microembolic signals. The incidence of early recurrence was 50% (3/6) in patients with microembolic signals and 3.8% (1/26) in patients without microembolic signals (P=0.02). The findings suggest that TCD monitoring of patients with recent cerebral ischaemia of presumed arterial origin allows recognition of a subset of patients at high risk for early recurrence.