When to consider cardioembolic stroke?

When to consider cardioembolic stroke?

Following features may help in thinking of a cardioembolic stroke when a person presents with stroke:

  1. Sudden onset to maximal neurological deficit
  2. Decreased level of consciousness at onset
  3. Wernicke’s aphasia or global aphasia without hemiparesis
  4. A Valsalva manoeuvre at the time of onset of stroke (can facilitate right to left shunt across a patent foramen ovale and consequently paradoxical emboli originating in the right side of the circulation and terminating the left side of the circulation)
  5. Co-occurrence of cerebral and systemic emboli [1].

Common cause for cardioembolic stroke would be atrial fibrillation, more so in the presence of mitral stenosis, previous large myocardial infarction with an akinetic segment or aneurysm, dilated cardiomyopathy, mechanical prosthetic heart valves and fragile atheromas in the proximal aorta.

Cardioembolic stroke is the most severe subtype of ischemic stroke. It comprises 14 to 30% of ischemic stroke [1]. They are more prone for early and delayed recurrence, though it may be preventable as by anticoagulation in atrial fibrillation. Left atrial appendage closure is an option in those with contraindications to anticoagulation. Closure of patent foramen ovale may also be considered.

Reference

  1. AdriĆ  Arboix, Josefina AliĆ³. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev. 2012;8:54-67.