title: Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit--the significance of transesophageal echocardiogram.
abstract: BACKGROUND
  The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine.
  
  
  OBJECTIVE
  To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests.
  
  
  METHODS
  Consecutive case series with historical controls.
  
  
  METHODS
  Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy.
  
  
  METHODS
  A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001.
  
  
  METHODS
  To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005.
  
  
  RESULTS
  More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p < 0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041).
  
  
  CONCLUSIONS
  Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.
authors.affiliation: Department of Internal Medicine, Vascular and Metabolic Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. a.martignoni@smatteo.it
authors.forename: A
authors.initials: A
authors.lastname: Martignoni
authors.forename: M
authors.initials: M
authors.lastname: Sartori
authors.forename: L
authors.initials: L
authors.lastname: Lanzarini
authors.forename: M
authors.initials: M
authors.lastname: Negri
authors.forename: I
authors.initials: I
authors.lastname: Martino
authors.forename: E
authors.initials: E
authors.lastname: Benedicti
authors.forename: E
authors.initials: E
authors.lastname: Marchesi
authors.forename: G
authors.initials: G
authors.lastname: Bertone
authors.forename: C
authors.initials: C
authors.lastname: Tinelli
authors.forename: F
authors.initials: F
authors.lastname: Falaschi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology