Jurnal Reading

Cardioembolic Stroke: Clinical

Features, Specific Cardiac
Disorders and Prognosis
Edwinda Desy Ratu
Pembimbing:
dr. Noviandi Herlambang, Sp.S, M.Si, Med

Introduction
Stroke is the leading cause of disability
and the second most common cause of
death worldwide
Cardioembolic stroke accounts for 1430% of all cerebral infarctions
Increases with age

Embolism from the heart to the brain results

from one of three mechanisms:
blood stasis and thrombus formation in
an enlarged left cardiac chamber
release of material from an abnormal
valvular surface
abnormal passage from the venous to
the arterial circulation

Cont..
There is no gold standard for making
the diagnosis of cardioembolic stroke
When cardiac and arterial disease
coexist, determining the etiology of
the ischemic stroke becomes more
difficult

Clinical Features
1. Sudden onset to maximal deficit (<
5 min) and decreased level of
consciousness
altered consciousness was a predictive
factor of cardioembolic infarction
Continues with a rapid regression of
symptoms (the spectacular shrinking
deficit syndrome)
Visual-field abnormalities

Clinical Features
2. Wernickes aphasia or global
aphasia without hemiparesis
Wallenbergs syndrome, cerebellar
infarcts, top of-the basilar syndrome,
multilevel infarcts, or posteriorcerebralartery infarcts

3. Other symptoms
headache, seizures at onset and onset
during activity

Clinical Features
Neuroimaging data
CT scan bihemispheric combined
anterior and posterior circulation, or
bilateral or multilevel posterior
infarcts are suggestive of
cardioembolism

Specific Cardiac Disorders

Common high risk cardioembolic
conditions are atrial fibrillation,
recent myocardial infarction,
mechanical prosthetic valve,
dilated myocardiopathy, and
mitral rheumatic stenosis

Atrial Fibrilation
The most important cause of
cardioembolic stroke
Prevalence of atrial fibrillation
increases with age, reaching a peak
of 5% in people over 65 years of age
Associated with valvular heart
disease, thyroid disorders,
hypertension, and recent heavy
drinking of alcohol

Acute Myocardial Infarction

Approximately 2.5% of patients with
acute myocardial infarction
experience a stroke within 2 to 4
weeks of the infarction
8% of men and 11% of women will
have an ischemic stroke within the
next 6 years

Mortality of Cardioembolic Infarction

Cardioembolic infarctions the highest inhospital mortality during the acute phase of
stroke
mortality rate was 27.3% as compared with
0.8% for lacunar infarcts and 21.7% for
atherothrombotic stroke
causes of death were as follows:
nonneurological (pneumonia, heart
disease, pulmonary thromboembolism,
sepsis, sudden death, and other causes
neurological, including brain herniation,
recurrence of cerebral ischemia and

Mortality of Cardioembolic Infarction

Early recurrent embolisms (within the first
7 days of stroke onset) were observed in
9 patients (3.9%) . Only one patient was
receiving therapeutic anticoagulation
In the multivariate analysis, four clinical
variables were significantly associated
with in-hospital mortality: age, congestive
heart failure, hemiparesis, and decreased
level of consciousness

Embolic Recurrence In
Cardioembolic Infarction
The risk of early stroke recurrence in
cerebral infarctions in general ranges
between 1% to 10% according to the
different series
recurrences within the first 3 months are
more common in cardioembolic infarction
Cerebral Embolism Task around 12% of
patients with cardioembolic infarctions
would develop a second embolism within
the first 2 weeks of the onset of symptoms

Embolic Recurrence In
Cardioembolic Infarction
clinical predictors of cardioembolic
stroke recurrence: alcohol abuse,
hypertension with valvular heart
disease and atrial, nausea and
vomiting, and previous cerebral
infarct

Early Differential Diagnosis Between

Cardioembolic And Atherothrombotic
Infarcts
Cardioembolic Infarcts Atherothrombotic
Infarcts
atrial fibrillation and
hypertension, chronic
sudden onset of
obstructive pulmonary
neurological symptoms
disease, diabetes,
dyslipemia, and age
seizures or headache

Atrial Fibrillation in Cardioembolic

and
Atherothrombotic Infarctions

Atrial fibrillation is the main cardiac

disorder in the different series of
cardioembolic infarctions
atrial fibrillation can be also observed
in atherothrombotic infarcts

Cardioembolic Infarctions with and

without Atrial Fibrillation
Coronary heart disease, smoking,
and topography of the infarct in the
internal capsule were more frequent
in cardioembolic stroke patients
without atrial fibrillation. The inhospital mortality rate was 31.6% in
patients with atrial fibrillation and
14.8% in those without atrial
fibrillation

Atherothrombotic Infarctions with

and without Atrial Fibrillation
In atherothrombotic infarcts without
atrial fibrillation, smoking,
involvement of the cranial nerves
and vertebral vascular topography
were more common. Absence of
functional dysfunction on hospital
discharge was also more frequent.

Cardioembolic Infarctions and

Atherothrombotic Infarctions with
Atrial Fibrillation