title: Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years.
abstract: Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old.
  
  
  OBJECTIVE
  To describe the transesophageal echocardiography (TEE) findings in young and non-young stroke patients without any prior evidence of cardiac source for cerebral embolism.
  
  
  METHODS
  Transversal study: 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to TEE.
  
  
  RESULTS
  Ten percent were aged 45 years; or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years; 2.8% of non-young patients had thrombus in left heart.
  
  
  CONCLUSIONS
  TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.
authors.affiliation: Division of Neurological Emergencies, São Paulo Federal University, São Paulo, Brazil. maiumi@neuro.epm.br
authors.forename: Marcia Maiumi
authors.initials: MM
authors.lastname: Fukujima
authors.forename: Solange Bernardes
authors.initials: SB
authors.lastname: Tatani
authors.forename: Alexandre Santos
authors.initials: AS
authors.lastname: Aguiar
authors.forename: Maria Elisabeth Matta de Rezende
authors.initials: ME
authors.lastname: Ferraz
authors.forename: Silvio
authors.initials: S
authors.lastname: Francisco
authors.forename: Luiz Darcy
authors.initials: LD
authors.lastname: Ferreira
authors.forename: Cláudia G
authors.initials: CG
authors.lastname: Monaco
authors.forename: Juarez
authors.initials: J
authors.lastname: Ortiz
authors.forename: João Augusto Costa
authors.initials: JA
authors.lastname: Lima
authors.forename: Alberto Alain
authors.initials: AA
authors.lastname: Gabbai
authors.forename: Gilmar Fernandes
authors.initials: GF
authors.lastname: do Prado
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*