Transient Cerebral Ischemia Due to Arrhythmia

Walter, Paul F.

doi:10.7326/0003-4819-72-4-471

Cited by 101 publications

(24 citation statements)

References 5 publications

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“…In one study 8 74% of 130 out-patients complaining of syncope and dizziness were found to have cardiac arrhythmias but none had focal cerebral symptoms. Walter et al, 4 investigating 39 patients with cerebral ischemia, found that 10 had significant arrhythmias on ambulatory ECG monitoring and 8 of these were in cases with diffuse cerebral symptoms. The remaining 2 patients who were described as having transient ischemic attacks had symptoms equally well explained on the basis of global ischemia.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrhythmias in acute stroke.

Norris¹,

Froggatt²,

Hachinski³

1978

Stroke

128

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SUMMARY Cardiac arrhythmias were more frequent (P < 0.001) in 312 stroke patients admitted to an intensive care stroke unit, than in 92 patients admitted to the unit and subsequently found not to have strokes. This significant difference remained when a stroke subgroup and the non-stroke group were matched for age, sex and duration of stay in the unit (P < 0.005). Hypertension and hypertensive cardiac disease were more common in the stroke than in the non-stroke patients (P< 0.001).Ectopic beats and atrial fibrillation, as well as other arrhythmias, were most frequent in patients with cerebral hemisphere infarction, and patients with hemispheric lesions had significantly more arrhythmias than those with brain stem lesions (P < 0.05).These arrhythmias were rarely (2%) responsible for hemodynamic ischemic cerebrovascular lesions, but may have been associated with cerebral embolism in up to 17% of cases. The cardiac arrhythmias appeared to have little influence on the course of the subsequent recovery from stroke. Although these arrhythmias frequently reflect the high incidence of cardiac disease in stroke patients, in some cases they are secondary to the acute cerebrovascular lesion itself.

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Section: Discussionmentioning

confidence: 99%

Cardiac arrhythmias in acute stroke.

Norris¹,

Froggatt²,

Hachinski³

1978

Stroke

128

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“…In one study it occurred in 16% of patients with chronic sinoatrial disorder against 1.3% of matched patients with complete heart block (Fairfax et al, 1976). Likewise transient cerebral ischaemia in other dysrhythmias lhas also been documented (Walter et al, 1970) though again its frequency has been denied (Reed et al, 1973).…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular incidents after myocardial infarction.

McAllen¹,

Marshall²

1977

Journal of Neurology, Neurosurgery & Psychiatry

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(Young et al., 1960). Correlation between the degree of atheroma of coronary and carotid arteries is likewise high (Young et al., 1960;Mitchell and Schwartz, 1965). When necropsy evidence of myocardial infarction is made the starting point, the prevalence of carotid stenosis is again high, the lumen of the sinus being reduced by half in 59% of men with myocardial infarction against 35% in unselected necropsies (Mitchell and Schwartz, 1965). Conversely, when atheroma of the carotid sinus is the starting point the prevalence of myocardial infarction rises from 8% in cases with mild atheroma to 67% in severe cases (Martin et al., 1960).Embolisation from the heart to the carotid and cerebral circulation is also a common pathological finding. In a series of cases of occlusion of the internal carotid artery 20% were caused by emboli

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“…No patient had had a significant dysrhythmia that was considered to be responsible for their symptoms previously diagnosed by clinical observation or standard EKG. Walter et al 5 found that 10-of the 39 patients monitored had transient cardiac dysrhythmia or conduction abnormalities that probably precipitated their neurological symptoms. Eight of the positive results were in patients with diffuse cerebrovascular symptoms, namely, episodic lightheadedness, dizziness, or syncope.…”

Section: Discussionmentioning

confidence: 99%

“…Walter et al 5 studied 39 patients with symptoms of cerebral ischemia. Twenty-eight had symptoms of diffuse cerebrovascular insufficiency, namely, dizziness, giddiness, or syncope, while 11 had TI As.…”

Section: Discussionmentioning

confidence: 99%

Long-term EKG monitoring in patients with cerebrovascular insufficiency.

McHenry¹,

Toole²,

Miller³

1976

Stroke

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SUMMARY Cardiac dysrhythmia may be responsible for signs of cerebrovascular insufficiency in some patients. Ten patients with cerebrovascular insufficiency were monitored for up to 24 hours with the Holter EKG monitor. Eight of the patients had transient ischemic attacks and two had mild deficits from a completed stroke. Eight of the ten patients had associated abnormal cerebral angiography, the most frequent finding being carotid stenosis. Holter EKG monitoring in these ten patients showed no abnormalities in four patients. The remaining six had a variety of cardiac dysrhythmias. Although there were a variety of cardiac, cerebrovascular, and neurological abnormalities in these ten patients, six of these patients had a disturbance in cardiac rhythm or conduction which could have been directly associated with or suggest an etiology for the patient's neurological event.CORDAY et al.1 -2 and others 3 7 have emphasized that cardiac dysrhythmias may affect the cerebral circulation. As Corday et al.2 pointed out, more than 50% of patients with cardiac dysrhythmias are not aware of a dysrhythmia and they may present to the physician with neurological manifestations or with symptoms of coronary insufficiency. Barnes 3 asserted that weakness, vertigo, nervousness, insomnia, and even syncope may occur. Such generalized symptoms of cerebral ischemia may be more frequent than realized. Corday et al.1 emphasized that rapid cardiac dysrhythmias are apt to induce sufficient reduction in cerebral perfusion to cause cerebral ischemia. If cerebral artery narrowing from atherosclerosis or kinking is also present, it is entirely possible that the collateral circulation to a vital area of the brain will fail because of a reduced head of pressure and blood flow. Sulg et al. 8 and Shapiro et al. 9 have demonstrated in man that cardiac dysrhythmias may significantly reduce cerebral blood flow (CBF). Recently, McAllen and Marshall' described patients with cardiac dysrhythmia with transient ischemic attacks (TIAs). They considered that the possibility of TIAs being due to cardiac dysrhythmias seemed to be insufficiently appreciated. As suggested by Corday et al., 2 the introduction of the Holter monitor 10 allows one to monitor patients to detect transient dysrhythmias that may be associated with generalized or focal neurological symptoms. The purpose of this report is to describe ten patients with cerebrovascular insufficiency who had long-term Holter electrocardiographic monitoring for the detection of cardiac dysrhythmia associated with cerebrovascular symptoms. MethodsNine patients were admitted to the Neurology Service of the North Carolina Baptist Hospital because of neurological symptoms suggestive of cerebrovascular insufficiency. One additional patient was admitted because of two episodes of syncope. As well as complete physical, neurological, and neurovascular examinations, aorta-cervical-cranial angiography was performed in each case. Similarly, up to 24-hour Holter EKG monitoring 10 was carried out in each patient to Sup...

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Transient Cerebral Ischemia Due to Arrhythmia

Cited by 101 publications

References 5 publications

Cardiac arrhythmias in acute stroke.

Cardiac arrhythmias in acute stroke.

Cerebrovascular incidents after myocardial infarction.

Long-term EKG monitoring in patients with cerebrovascular insufficiency.

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