title: Clinical features of cardioembolic strokes identified by transesophageal echocardiography.
abstract: Clinical and CT scan features predictive of a cardiac source of embolism (CSOE) are helpful in planning appropriate investigations in ischaemic strokes. The currently described predictors of CSOE were determined before the availability of trans esophageal echocardiography (TEE). After the advent of TEE, many new CSOE were discovered. The present study was planned to investigate if the previously described predictors of CSOE are also valid for patients with CSOE detectable only with TEE (TEE-detected CSOE). From 1992-1995, 485 consecutive patients of ischemic stroke were enrolled in the Maryland Stroke Data Bank (MSDB). Patients with CSOE identified only by TEE and not by clinical, electrocardiographic or transthoracic echocardiographic (TTE) examination were compared to patients with a CSOE with respect to the features of the history, neurologic examination and CT scan. Of 485 patients with cerebral infarction, 132 (27%) patients had CSOE. In 21/132 (16%), diagnosis of high risk CSOE could be established only by TEE. The most discriminating clinical findings in TEE-detected CSOE patients were visual field deficit (OR 2.9; 95% CI, 1.1-7.4) and neglect (OR 3.4; 95% CI,1.2-9.3). Less strong associations were also found with other clinical features described previously for CSOE. No significant differences were found for features of the initial CT scan. In summary, presence of visual field defect and hemineglect may suggest a higher likelihood of finding a CSOE by TEE, even if the clinical cardiac examination and TTE are normal.
authors.affiliation: Departments of Neurology, Epidemiology and Preventive Medicine and Medicine, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kaul
authors.forename: S J
authors.initials: SJ
authors.lastname: Kittner
authors.forename: M A
authors.initials: MA
authors.lastname: Woznaik
authors.forename: M A
authors.initials: MA
authors.lastname: Sloan
authors.forename: M
authors.initials: M
authors.lastname: Corretti
authors.forename: J R
authors.initials: JR
authors.lastname: Hebel
authors.forename: T R
authors.initials: TR
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed