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

Humphrey, R. D.; Harrison, Michael J.

doi:10.1136/pgmj.61.722.1039

Cited by 19 publications

(4 citation statements)

References 13 publications

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“…Ischemic stroke subtype diagnoses were rendered retrospectively at 5 possible time points: (1) immediately before DWI/MRA imaging (based on history, physical examination, and CT or conventional MRI studies), (2) immediately after DWI imaging (without MRA data), (3) immediately after MRA imaging (without DWI data), (4) immediately after combined DWI/MRA, and (5) at hospital discharge (final diagnosis).…”

Section: Methodsmentioning

confidence: 99%

Impact on Stroke Subtype Diagnosis of Early Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Angiography

Lee

Kidwell

Alger

et al. 2000

Stroke

231

166

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Background and Purpose-The purpose of the present study was to assess the diagnostic usefulness of early diffusion-weighted MRI (DWI) and MR angiography (MRA) in patients with ischemic stroke. Past approaches to stroke diagnosis required a series of diagnostic tests over several days of hospitalization. New magnetic resonance methodologies that include DWI and MRA may allow more rapid characterization of stroke pathophysiology. However, no previous study has assessed the impact on formal stroke subtype diagnosis of early imaging with DWI/MRA. Methods-We analyzed 46 consecutive patients with acute ischemic stroke who underwent DWI/MRA within 24 hours of admission. Initial diagnoses were rendered with use of the 2 most widely used formal stroke subtype classification schemes, the TOAST and the Oxfordshire methods, which were applied to patients after CT/conventional MRI but before DWI/MRA. Modified TOAST and Oxfordshire diagnoses were then rendered based on the results of day 1 DWI, MRA, and DWI plus MRA. Final TOAST/Oxfordshire diagnoses at discharge were taken as the gold standard. Results-Compared with final diagnoses, pre-MRI TOAST diagnoses matched final diagnoses in 48%, improving to 83% after DWI alone, 56% after MRA alone, and 94% after DWI plus MRA. For the TOAST diagnostic subtypes of large-vessel atherothromboembolism and small-vessel disease, pre-MRI diagnoses matched final diagnoses in 56% and 35% of patients, respectively, improving to 89% and 100% after DWI/MRA. Pre-MRI Oxfordshire diagnoses matched final diagnoses in 67% of patients, improving to 100% after DWI. Conclusions-The use of DWI/MRA within 24 hours of hospitalization substantially improves the accuracy of the diagnosis of early ischemic stroke subtype. When initial management and clinical trial eligibility decisions are influenced by stroke subtype, day 1 multimodal MRI is advantageous as a guide to therapy. (Stroke.

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Section: Methodsmentioning

confidence: 99%

Impact on Stroke Subtype Diagnosis of Early Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Angiography

Lee

Kidwell

Alger

et al. 2000

Stroke

231

166

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“…Both left atrial thrombi and left ventricular thrombi as cerebral embolicsourceshavebeenassociatedwith left ventricular wall motion abnormalities 23 and left ventricular dysfunction, 24,25 with and without AF. 21, [23][24][25][26][27][28][29]45 In addition to NVAF, cardiac sequelae of atherosclerosis developed in NASCET subjects, including symptomatic coronary heart disease, MI, and congestive heart failure, in some cases requiring invasive therapeutic interventions. All these factors are known to have potential for the formation or dislodgement of aortic, atrial, and ventricular thrombi or atheromatous fragments causing embolic stroke.…”

Section: Commentmentioning

confidence: 99%

Causes and Severity of Ischemic Stroke in Patients With Internal Carotid Artery Stenosis

Barnett

Gunton²,

Eliasziw³

et al. 2000

JAMA

209

127

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Our data suggest that approximately 20% and 45% of strokes in the territory of symptomatic and asymptomatic carotid arteries with 70% to 99% stenosis, respectively, are unrelated to carotid stenosis. The cause of subsequent strokes in similar types of patients should be considered when making treatment decisions involving carotid endarterectomy for patients with asymptomatic carotid stenosis, since lacunar and cardioembolic strokes cannot be prevented by endarterectomy.

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“…Though clinical detection of possible cardiac sources of embolism underestimates their rate of discovery at autopsy, 4 the identification of atrial fibrillation is simple and it is unlikely that many cases are missed.…”

Section: Commentmentioning

confidence: 99%

Atrial fibrillation, TIAs and completed strokes.

Harrison¹,

Marshall²

1984

Stroke

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SUMMARY A retrospective survey of 1076 patients with completed strokes and 789 with transient ischemic attacks (TIAs) revealed that 5.6% of those with completed strokes but only 1.6% of those with TIAs were in atrial fibrillation. TIAs in the presence of atrial fibrillation tended to last longer than 60 minutes except in individuals who had coexistent carotid disease that might have been the source of their attacks. It is suggested that emboli from the fibrillating atrium rarely cause brief TIAs, and more usually cause 'long' TIAs or completed strokes.Stroke Vol 15, No 3, 1984

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

Cited by 19 publications

References 13 publications

Impact on Stroke Subtype Diagnosis of Early Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Angiography

Impact on Stroke Subtype Diagnosis of Early Diffusion-Weighted Magnetic Resonance Imaging and Magnetic Resonance Angiography

Causes and Severity of Ischemic Stroke in Patients With Internal Carotid Artery Stenosis

Atrial fibrillation, TIAs and completed strokes.

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