Recurrent Cerebral Embolism and Factors Related to Early Recurrence - Analysis of 186 Consecutive Cases

Abstract

Clinical profiles of cerebral embolism were studied in relation to the factors and incidence of recurrent attacks in a series of 186 consecutive cases, who were diagnosed as certain cerebral embolism based on our diagnostic criteria.

Atrial fibrillation (AF) without valvular heart disease (59 cases) and valvular heart disease (58 cases) were the two main underlying cardiac disorders.

More than 90 % of the remaining 69 cases were found to have various types of cardiac diseases.

Within 2 weeks prior to the cerebral episode which caused admission to our hospital, 24 patients (13 %) had experienced 27 episodes of cerebral (14) and/or systemic (13) embolization, suggesting an importance of minor episodes as a warning sign of major strokes. During acute stage (-2 wks) recurrent cerebral episodes were observed in 0.51 %/patient-day and systemic embolization in 0.81 %/pt-day, which were significantly more frequent than those in subacute (2–4 wks) and chronic (4–8 wks) stages. Fourteen percent of recurrent cerebral and 18 % of systemic embolization were attributable to direct cause of death.

Incidence of early recurrent episodes to the brain in patients with AF was approximately the same as that in VHD patients, but early systemic embolization occurred more frequently in VHD than in AF patients.

Early anticoagulation appeared to be effective as far as the recurrent episodes were concerned. On the contrary administration of urokinase in acute stage seemed to increase the recurrence rate.