title: Transesophageal echocardiography in patients with cryptogenic cerebral ischemia.
abstract: BACKGROUND
  In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke). In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients.
  
  
  METHODS
  Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver) was performed in all patients
  
  
  RESULTS
  702 consecutive patients (380 male, 383 IS, 319 TIA, age 18-90 years) were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%), previously undiagnosed valvular disease (15.8%), aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291) and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003). The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014).
  
  
  CONCLUSIONS
  A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke - irrespective of age - because of specific therapeutic consequences.
authors.affiliation: Charité Universitatsmedizin Berlin, Campus Mitte, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie und Angiologie, Berlin, Germany. fabian.knebel@charite.de
authors.forename: Fabian
authors.initials: F
authors.lastname: Knebel
authors.forename: Florian
authors.initials: F
authors.lastname: Masuhr
authors.forename: Wolfram
authors.initials: W
authors.lastname: von Hausen
authors.forename: Torsten
authors.initials: T
authors.lastname: Walde
authors.forename: Henryk
authors.initials: H
authors.lastname: Dreger
authors.forename: Vanessa
authors.initials: V
authors.lastname: Raab
authors.forename: Mahsun
authors.initials: M
authors.lastname: Yuerek
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges