Cerebral embolism in the Michael Reese Stroke Registry.

Caplan, Louis R.; Hier, Daniel B.; D’Cruz, Ivan A.

doi:10.1161/01.str.14.4.530

Cited by 228 publications

(91 citation statements)

References 40 publications

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“…[21] Coronary artery disease, atrial fibrillation, valvular heart disease, mitral annulus calcification, and cardiomyopathy were the commonest etiologies. Echocardiography documented a potential embolic source in 7 patients without previously known heart disease and clarified the cardiac pathology in many of the patients with known heart disease.…”

Section: Discussionmentioning

confidence: 99%

An Echocardiographic Study in Patients with Non Haemorrhagic Cerebral Infarction to Find Cardiac Abnormalities

Bansal

Singh

et al. 2016

International Journal of Medical and Dental Sciences

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Section: Discussionmentioning

confidence: 99%

An Echocardiographic Study in Patients with Non Haemorrhagic Cerebral Infarction to Find Cardiac Abnormalities

Bansal

Singh

et al. 2016

International Journal of Medical and Dental Sciences

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“…However, reports of migratory cardioembolic events that occlude penetrating vessel ostia are reported, but their involvement is typically greater than 1 cm in parenchymal size. Cardioembolic stroke affecting the posterior circulation accounts for ≤25% of posterior circulation ischemic events in some registries [18][19][20][21][22][23][24][25][26].…”

Section: Evaluation Of Patients At Risk For Cardioembolic Strokementioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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“…Previous reports suggest that 6-39%of ischemic stroke are caused by cardiogenic emboli (3)(4)(5)(6)(7)(8). Left atrial spontaneous echo contrast and thrombus formation associated with atrial fibrillation have been reported as one of the most important cardiac sources of embolism (9-13).…”

Section: Introductionmentioning

confidence: 99%

Transesophageal Echocardiographic Detection of Cardiac Sources of Embolism in Elderly Patients with Ischemic Stroke.

Okura¹,

Inoue²,

Tomon³

et al. 1999

Intern. Med.

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Objective The aim of this study was to clarify the role of transesophageal echocardiography in detecting cardiac sources of embolism in elderly stroke patients. Methods Weperformed transesophageal echocardiography in 77 patients>70 years old (mean 76.9) with ischemic stroke and investigated embolic sources. Thirty-seven patients were in sinus rhythm (SR) and 40 in atrial fibrillation (Af). Results Left atrial spontaneous echo contrast was detected in 73%of Af and in 14%of SR (p<0.01). Left atrial thrombus was present in 10%ofAf and none of SR (p<0.05). Patent foramen ovale, atrial septal aneurysm, and aortic atherosclerotic plaque>4.0 mmin thickness in the proximal aortic arch were more commonlyfound in patients with SR. Conclusions In elderly ischemic stroke patients, 1) Left atrial spontaneous echo contrast and thrombus are more commonlydetected in patients with Af, reflecting left atrial enlargement and blood stasis, and 2) atrial septal aneurysm, patent foramen ovale and aortic atherosclerotic plaque>4.0 mmin thickness in the proximal aortic arch are important findings in patients with SR. (Internal Medicine 38: 766-772, 1999) Key words: cerebral embolism, embolic source, diagnosis IntroductionRecently, hemorrhagic stroke has remarkably decreased in Japan. However, the prevalence of ischemic stroke has shown a rather gradual decrease. Furthermore, the morbidity and mortality of ischemic stroke is still high and has increased with advancing age (1, 2). Therefore, it is still a major concern for us to determine how to prevent and manage elderly patients with ischemic stroke.For editorial comment, see also p 753.Previous reports suggest that 6-39%of ischemic stroke are caused by cardiogenic emboli (3-8). Left atrial spontaneous echo contrast and thrombus formation associated with atrial fibrillation have been reported as one of the most important cardiac sources of embolism (9-13). Using transesophageal echocardiography, other possible sources of embolismincluding atrial septal aneurysm (14-19), patent foramen ovale (18,(20)(21)(22)(23)(24)(25)(26)(27) and aortic atherosclerotic plaque (28-40) have been reported as independent risk factors of ischemic stroke. However, previous studies have not showncharacteristics of an embolic source in an elderly patient with ischemic stroke. Therefore, we designed this study to characterize the sources of embolism in elderly ischemic stroke patients with both sinus rhythm and atrial fibrillation and to clarify the role of transesophageal echocardiographic examination in elderly patients. Subjects and MethodsBetween June 1995 and September 1997, we recruited patients older than age 70 years with "completed ischemic stroke" referred to the echocardiography laboratory of Kobe Rehabilitation Hospital for a transesophageal echocardiographic examination. The study group consisted of 77 consecutive patients (47 men and 30 women, age ranged 70 to 90 years, mean 76.9±4.4 years). Thirty-seven patients were in sinus rhythm (SR) and 40 in atrial fibrillation (Af).All patients underwe...

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Cerebral embolism in the Michael Reese Stroke Registry.

Cited by 228 publications

References 40 publications

An Echocardiographic Study in Patients with Non Haemorrhagic Cerebral Infarction to Find Cardiac Abnormalities

An Echocardiographic Study in Patients with Non Haemorrhagic Cerebral Infarction to Find Cardiac Abnormalities

Prevention of Cardioembolic Stroke

Transesophageal Echocardiographic Detection of Cardiac Sources of Embolism in Elderly Patients with Ischemic Stroke.

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