[Cerebral embolism without apparent cause: angiographic study of minor predisposing cardiac anomalies. Prospective study of 64 patients].
The heart is the source of about 50 p. 100 of cerebral emboli. In the absence of clinically obvious cardiac disease, the heart is nevertheless suspected to be the origin, especially in young patients without atherosclerosis. Cardiac catheterisation and angiography were performed systematically to detect minor predisposing cardiac abnormalities which did not appear on standard clinical examination, and which could increase the risk of recurrent embolism. 64 patients aged 21 to 69 years were studied prospectively a few weeks after a cerebral vascular accident attributed to embolism on the results of complementary neurological investigation, or, more rarely, after systemic embolism to one of the limb arteries. Clinical examination, chest X-ray and the electrocardiogram were normal in all cases. The investigation consisted in right and left cardiac catheterisation, global angiography after right atrial injection, selective left ventricular angiography and coronary angiography in all patients over 40 years of age. Unsuspected cardiac abnormalities were detected in 39 of the 64 patients (60 p. 100); the main abnormalities were mild or moderate mitral valve prolapse (30 p. 100 of cases) and slight decreases in left ventricular contractility possibly related to a minor form of cardiomyopathy (23 p. 100 of cases). Ambulatory 24 hour monitoring showed supraventricular arrhythmias in 30 p. 100 of cases. The results of echocardiography were disappointing in the diagnosis of these minor abnormalities. In conclusion, cardiac abnormalities were detected in the majority of cases of cerebral embolism by cardiac catheterisation. These results support the indications for long-term anticoagulant and/or anti-arrhythmic treatment in these patients.
D000328:Adult; D000368:Aged; D000792:Angiography; D017023:Coronary Angiography; D004562:Electrocardiography; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011446:Prospective Studies
Embolies cérébrales sans cause apparente: recherche par angiographie d'anomalies cardiaques mineures prédisposantes. Etude prospective sur 64 patients.