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

Abstract

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.

A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. The National Research Council Study Group.

“…'9,20 Cardiac abnormalities were detected in 30.3% of our patients with routine ECG and echocardiography.1" 24,25 Potential cerebral embolism of cardiac origin was diagnosed in 23.7% of our patients. With reference to the conventional sources alone, the percentage became notably lower (7.5%).…”

An unusual cause of stroke in an older patient

“…PFEs are histologically benign endocardial papillomas that predominantly affect cardiac valves 4. They are the second most common benign primary cardiac tumours (after myxomas) and account for three-quarters of all cardiac valve tumours.…”