Summary
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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Abbreviations
- CVA:
-
cerebrovascular accident
- TIA:
-
transient ischemic attack
- OA:
-
ophthalmic artery
- ACA:
-
anterior cerebral artery
- MCA:
-
middle cerebral artery
- VBA:
-
vertebrobasilar artery territory
- ECG:
-
electrocardiography
References
Adams HP, Putman SF, Corbett JJ, Sires BP, Thompson HS (1983) Amaurosis fugax: the results of arteriography in 59 patients. Stroke 5:742–744
Amaurosis Fugax Study Group (1990) Current management of amaurosis fugax. Stroke 21:201–208
Andersen CU, Marquardsen J, Mikkelsen B, Nehen JH, Pedersen KK, Vesterlund T (1988) Amaurosis fugax in a Danish community: a prospective study. Stroke 19:196–199
Asinger RW, Mikell FL, Sharma B, Hodges M (1981) Observations on detecting left ventricular thrombus with two-dimensional echocardiography: Emphasis on avoidance of false positive results. Am J Cardiol 7:145–156
Barnett HJM, Bonghner DR, Taylor DW, Cooper PE, Kostuk WJ, Nichol PM (1980) Further evidence of relating mitral-valve prolapse to cerebral ischemic events. N Engl J Med 302:139–144
Berlit P (1983) Die kardiale Hirnembolie. Nervenarzt 54:389–399
Berlit P, Eckstein H, Krause KH (1986) Die Prognose der kardialen Hirnembolie. Fortschr Neurol Psychiat 54:205–215
Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne stroke registry: analysis of 1,000 consecutive patients with first stroke. Stroke 19:1083–1092
Caplan LR, Hier D, D'Cruz I (1983) Cerebral embolism in the Michael Reese Stroke Registry. Stroke 14:530–537
Cerebral Embolism Study Group (1983) Immediate anticoagulation of embolic stroke: A randomized trial. Stroke 14:668–676
Cerebral Embolic Task Force (1986) Cardiogenic brain embolism. Arch Neurol 43:71–84
De Bono D (1983) Cardiac causes of stroke. In: Ross Russell RW (ed) Vascular disease of the central nervous system. Churchill Livingstone, Edinburgh London Melbourne New York, ed 2, pp 324–336
De Bono DP, Warlow CP (1981) Potential sources of emboli in patients with presumed transient cerebral or retinal ischemia. Lancet 1:343–346
Diener HC, Einhäupl KM (1988) Zerebrale Ischämie. In: Brandt Th, Dichgans J, Diener HC (Hrsg) Therapie und Verlauf neurologischer Erkrankungen, Kohlhammer, Stuttgart Berlin Köln Mainz, S 245–258
Gates PC, Barnett HJM, Silver MD (1986) Cardiogenic stroke. In: Barnett HJM, Mohr HP, Stein BM, Yatsu FM (eds) Stroke: pathophysiology, diagnosis, and management. Churchill Livingstone, New York Edinburgh London Melbourne, vol 2, pp 1085–1109
Herrschaft H (1990) Herzkrankheiten als Ursache zerebraler Symptome und Syndrome. Fortschr Neurol Psychiat 58:287–300
Hoffmann Th, Kasper W, Meinertz Th, Geibel A, Just H (1990) Echocardiographic evaluation of patients with clinically suspected arterial emboli. Lancet ii:1421–1424
Hornig CR, Will R, Dorndorf W (1989) Ischämische zerebrale Insulte bei Vorhofflimmern. Eine retrospektive Untersuchung. Akt Neurol 16:195–200
Kollegger H, Smoliner H, Dal-Bianco P, Oder W, Zeiler K, Deecke L (1988) Der Mitralklappenprolaps als Risikofaktor für den juvenilen Insult. Nervenarzt 59:629–635
Komrad MS, Coffey CE, Coffey KS, McKinnis R, Massey EW, Califf RM (1984) Myocardial infarction and stroke. Neurology 34:1403–1409
Love BB, Struck LK, Stanford W, Biller J, Kerber M, Marcus M (1990) Comparison of two-dimensional echocardiography and ultrafast cardiac computed tomography for evaluating intracardiac thrombi in cerebral ischemia. Stroke 21:1033–1038
Masuda J, Yutani C, Imakita M, Ishibashi-Ueda, Ogata J, Omae T (1990) Clinicopathological study of cardiogenic cerebral embolism — a review of autopsy cases in the national cardiovascular center. Stroke 21, Suppl 1:I-50
Muuronen A, Kaste M (1982) Outcome of 314 patients with transient ischemic attacks. Stroke 13:24–31
Pearson AC, Labovitz AJ, Tatineni A, Gomez CR (1991) Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of unknown etiology. J Am Coll Cardiol 17:66–72
Poole CJM, Ross Russell RW (1985) Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry 48:902–905
Poole CJM, Ross Russell RW, Harrison P, Savidge GF (1987) Amaurosis fugax under the age of 40 years. J Neurol Neurosurg Psychiatry 50:81–84
Pop G, Sutherland GR, Koudstaal PJ, Sit TW, de Jong G, Roelandt JRTC (1990) Transesophageal echocardiography in the detection of intracardiac embolic sources in patients with transient ischemic attacks. Stroke 21:560–565
Ramirez-Lassepas M, Cipolle RJ, Bjork RJ, Kowitz J, Snyder BD, Weber JC, Stein SD (1987) Can embolic stroke be diagnosed on the basis of neurological clinical criteria? Arch Neurol 44:87–89
Sirna S, Biller J, Skorton DJ, Seabold JE (1990) Cardiac evaluation of the patient with stroke. Stroke 21:14–23
Tharakan J, Ahuda GK, Manchanda SC, Khanna A (1982) Mitral valve prolapse and cerebrovascular accidents in the young. Acta Neurol Scand 66:295–302
Wolf PA, Kannel WB, McGee DL, Meeks SL, Bharucha NE, McNamara PM (1983) Duration of atrial fibrillation and imminence of stroke: The Framingham Study. Stroke 14:664–667
Wolf PA, Sila CA (1987) Cerebral ischemia with mitral valve prolapse. Am Heart J 113:1308–1315
Zenker R, Erbel R, Krämer G, Mohr-Kahaly S, Drexler M, Harnoncourt K, Meyer J (1988) Transesophageal two-dimensional echocardiography in young patients with cerebral ischemic events. Stroke 19:345–348
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Oder, W., Siostrzonek, P., Lang, W. et al. Distribution of ischemic cerebrovascular events in cardiac embolism. Klin Wochenschr 69, 757–762 (1991). https://doi.org/10.1007/BF01797614
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DOI: https://doi.org/10.1007/BF01797614