title: In-hospital onset ischemic stroke may be associated with atrial fibrillation and right-to-left shunt.
abstract: OBJECTIVE
  Ischemic stroke during hospitalization can occasionally be found, but the mechanisms and causes underlying stroke have not been investigated in detail. The present study aimed to identify differences in stroke etiology between in-hospital and out-of-hospital onset.
  
  
  METHODS
  Subjects comprised 357 consecutive patients (221 men, 136 women) with ischemic stroke prospectively enrolled within 24 h of onset. Contrast saline transcranial Doppler ultrasonography (c-TCD) or transesophageal echocardiography (TEE) was performed in all participants to identify right-to-left shunts (RLS). Patients were divided into 2 groups: in-hospital onset (IHO group, n=49); and out-of-hospital onset (OHO group, n=308). Clinical characteristics were compared between groups.
  
  
  RESULTS
  Mean age was 71.5+/-12.3 years. Mean National Institute of Health stroke scale score was 6.9+/-7.2. RLS, atrial fibrillation (AF) and malignancy were more frequent in the IHO group than in the OHO group (39% vs. 20%, p=0.006; 45% vs. 16%, p<0.001; 18% vs. 4%, p<0.001, respectively). AF and/or RLS was more frequent in the IHO group (61%) than in the OHO group (30%, p<0.001).
  
  
  CONCLUSIONS
  Ischemic stroke with in-hospital onset may be associated with AF and RLS.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama, 701-0192, Japan. yigu@med.kawasaki-m.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Kazuto
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwanaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D015984:Causality; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial