Atheromatous Disease of the Carotid Arterial System and Embolism From the Heart in Cerebral Infaroton: A Morbid Anatomical Study

Mechanism of late stroke after myocardial infarct: the Lausanne Stroke Registry.

“…14 30 37 38 Also, only 14% of the patients with old myocardial infarction reported prior TIAs ipsilateral to the cerebral infarction, which have usually been linked to an atherothrombotic mechanism, though they may also occur in cardioembolic stroke. '0'7 '8 Finally, cerebral infarct involved the superficial MCA territory in nearly half of our patients with old myocardial infarction, a location which suggests an embolic mechanism,39 40 but which may not allow distinction of an arterial from a cardiac source of embolism, though the proportion of cardioembolism is higher in posterior MCA territory infarcts and lower in anterior MCA territory infarcts.0 Though many patients with old myocardial infarction have coexisting small and large artery disease, there is a subgroup of patients in whom we were unable to find another potential cause of stroke. These data suggest that myocardial infarction and its direct cardiac consequences may be a cause of stroke not only acutely but also thereafter.…”

How often can an embolic stroke be diagnosed clinically? A clinicopathological correlation

“…Of the group proven at Blackwood et al (1969), only 61% were thought clinically to have had an embolic stroke prior to death. Thus, though autopsy showed 45% of fatal strokes to be due to cardiac emboli, clinical detection was only achieved in 24%, a figure in keeping with clinical surveys from a similar era.…”

“…The true incidence is difficult to define. There is conflict between clinical studies (Carter, 1957;Groch et al, 1961;Kurtzke, 1976), most of which suggest that only 5-20% of strokes arise from cardiac emboli, and post-mortem data which show that as many as 50% of fatal strokes are so caused (Blackwood et al, 1969;Torvik & Jorgensen, 1969). It is possible that cardiac embolic strokes are more frequently lethal so biasing the results of autopsy studies but it also seems likely that clinical detection is faulty.…”

Differential Diagnosis of Acute Stroke: A Review

“…However, angiography is often necessary. Cerebral infarctions may be caused by embolism from the heart or great vessels in up to half the cases (Blackwood et al 1969). The clinical separation of thrombosis from embolism based on the characteristics of the onset is usually impossible.…”