Cardiac evaluation of the patient with stroke.

Sirna, Sara; Biller, José; Skorton, David J.; Seabold, James E.

doi:10.1161/01.str.21.1.14

Cited by 41 publications

(14 citation statements)

References 103 publications

(55 reference statements)

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“…As also found in the present study, preference for the carotid circulation in embolic strokes as well as leftsided predominance have been reported: 78%-90% of all cardiogenic emboli to the brain lodge in the middle cerebral artery [7,15,29]. In a clinicopathological analysis of 142 proven cases of cerebral embolism, Masuda et al [22] found the middle cerebral artery territory affected in 113 cases, and the area supplied by the verebrobasilar arteries in 37 cases.…”

Section: Discussionsupporting

confidence: 82%

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Distribution of ischemic cerebrovascular events in cardiac embolism

et al. 1991

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Distribution and number of ischemic cerebrovascular events were studied in 57 patients who suffered from heart disorders with proven or highly probable source of cardiac embolism and compared to 39 patients with ulcerations of the craniocervical vessels. Patients with coexisting lesions were excluded from the present study. Out of the 57 patients with cardiac disorders, a single episode of cerebral embolism occurred in 33 patients. Of the 24 patients with recurrent ischemic episodes, different vascular territories were involved in only six cases. There was no evidence of a distinct distribution of vascular territories involved in cerebral embolism. The left middle cerebral artery was affected in 42.9%, the right middle cerebral artery in 23.8%, the vertebrobasilar territory in 19%, and the ophthalmic arteries in 14.2%. Statistical analysis revealed no significant differences in lesion localization between the group with a cardiac source of embolism and the group with ulcerations of the craniocervical vessels. There was a high frequency of patients with recurrent cardiogenic emboli in the ophthalmic (6 of 9 patients) as well as in the vertebrobasilar (6 of 12 patients) circulation who experienced a delayed initiation of cardiac assessment. The possibility of cardiac embolism should be considered in any patient with cerebral ischemia, independently of the vascular territory affected.

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Section: Discussionsupporting

confidence: 82%

“…With emphasis on coronary heart disease, there is increasing evidence that the prognosis of patients with cerebrovascular disease is critically influenced by cardiac disorders [12,29].…”

Section: ]mentioning

confidence: 99%

Distribution of ischemic cerebrovascular events in cardiac embolism

et al. 1991

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“…Coronary artery disease was more extensive (P=.O12), and a higher percentage of these patients had a history of peripheral C erebral embolism from cardiac disease and cerebrovascular arterial disease are common causes of embolic neurological events in a significant number of patients. 1 Cardiac emboli can arise from thrombi in the left ventricle, left atrium, or left atrial appendage or paradoxically from the right atrium through an atrial septal defect or patent foramen ovale.…”

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confidence: 99%

Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients.

Dávila‐Román

Barzilai

Wareing

et al. 1994

Stroke

212

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The cause of cerebral and peripheral embolism remains undetermined in a significant number of patients. An atherosclerotic thoracic aorta has thus far been considered to be an uncommon one. To define the potential role of the ascending thoracic aorta as an embolic source, intraoperative ultrasonic aortic imaging was performed in 1200 of 1334 consecutive patients aged 50 years and older who were undergoing cardiac surgery. Patients were divided into two groups according to the results of the ultrasound study in terms of presence or absence of atherosclerotic disease. The prevalence of previous neurological events in the two groups was characterized and compared. Ascending aortic atherosclerosis was present in 231 (19.3%) of the patients studied. Patients in this category were older (P < .0001). A higher percentage of them were smokers (P < .0001) compared with patients with less severe disease. Coronary artery disease was more extensive (P = .012), and a higher percentage of these patients had a history of peripheral vascular disease (P < .0001). Univariate analysis of the subjects with (n = 158) and without (n = 1042) previous neurological events indicated that age, body mass index, atrial fibrillation, hypertension, and atherosclerosis of the ascending aorta were associated significantly with previous occurrence of a cerebrovascular accident. For the group as a whole, multiple logistic regression analysis demonstrated that hypertension (odds ratio, 1.81; P = .002), atherosclerosis of the ascending aorta (odds ratio, 1.65; P = .013), and atrial fibrillation (odds ratio, 1.54; P = .060) were significantly and independently associated with the occurrence of previous neurological events. Atherosclerosis of the ascending aorta is an independent risk factor for cerebrovascular events. An atherosclerotic ascending aorta may represent a potential source of emboli or may be a marker of generalized atherosclerosis.

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“…Among the possible causes of cerebral ischemia in young adults mitral valve prolapse appears to be one of the commonest [8, [24][25][26][27], Nevertheless, if restrictive echocardiographic criteria are adopted [15,28], mitral valve prolapse is less frequently identified [3. 5, 6].…”

Section: Discussionmentioning

confidence: 99%

“…Two-dimensional echocardiography is the main noninvasive imaging technique for detecting occult cardiac diseases, and identifying the anatomical features of the embologenic lesions [ 10], Nevertheless, the indications of two-dimensional echocardiography in patients with re cent cerebral ischemia are still debated [11][12][13][14][15].…”

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confidence: 99%

Role and Indication of Two-Dimensional Echocardiography in Young Adults with Cerebral Ischemia: A Prospective Study in 125 Patients

Urbinati¹,

Pasquale²,

Andreoli

et al. 1992

Cerebrovasc Dis

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We prospectively evaluated 125 patients with cerebral ischemia aged less than 45 years with cerebral angiography, CT and cardiac tests including two-dimensional echocardiography. Cardiac abnormalities were disclosed in 36 patients (33.6%). Potential sources of embolism were detected in 17 patients (15.8%); in 13 of them the cardiac lesion had previously been unrecognized. Mitral valve prolapse was the commonest cardiac lesion (6.5%). In 5 of these patients carotid atherosclerotic lesions were absent, and associated prothrom-botic factors were always present. In the remaining 2 cases dysplasia and/or dissection of carotid arteries were disclosed. Six patients showed an ''idiopathic'' aortic dilation; in 4 of them dysplasia or dissection of carotid arteries was observed. The ''idiopathic'' pattern of aortic root dilation (dilation limited to the first tract of the aortic root, normal echogenicity and aortic profile) was different from the ''atherosclerotic'' pattern (extensive dilation, increased echogenicity, irregular profile of aortic wall). Only few patients had cardiac lesions with high embolic risk, most patients having asymptomatic, previously unrecognized cardiac diseases. Therefore two-dimensional echocardiography is warranted for the etiological screening of cerebral ischemia in young adults. The detection of a cardiac lesion with low or unknown embolic risk should not preclude a search for other coexisting or prothrombotic factors. Finally, mitral valve prolapse and idiopathic aortic root dilation may be an expression of a minor connective tissue disorder accountable for dysplasia or dissection of carotid arteries.

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Cardiac evaluation of the patient with stroke.

Cited by 41 publications

References 103 publications

Distribution of ischemic cerebrovascular events in cardiac embolism

Distribution of ischemic cerebrovascular events in cardiac embolism

Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients.

Role and Indication of Two-Dimensional Echocardiography in Young Adults with Cerebral Ischemia: A Prospective Study in 125 Patients

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