Transcript Embolic Stroke

Embolic Stroke
Emily Chang
PGY-3
May 4, 2010
Definition
Particles of debris that originate from
another source that lead to blockage of
arterial perfusion of a region in the
brain
Approximately 20-30% of ischemic
strokes are cardioembolic
Generally worse prognosis than
thrombotic strokes as the area infarcted
is usually larger due to large emboli
What to Look For
Cardiac arrhythmias
Cardiac murmurs
Signs of CHF
Recent MI
Concomitant diseases (SLE,
endocarditis, neoplasias)
Other signs of systemic embolism
Time course
Usually abrupt onset that is maximal at
the start
Symptoms may clear entirely since the
emboli can migrate and lyse
Multiple sites in different vascular beds
may be affected leading to different
symptoms at different times
Types
known cardiac source
possible cardiac or aortic source based
on TTE or TEE
arterial source
unknown source with negative tests for
embolic sources
Major risk sources
Atrial fibrillation (accounts for 50%)
Rheumatic valve disease
Bioprosthetic and mechanical heart valves
Atrial or ventricular thrombus
SSS
Sustained atrial flutter
MI within one month
CHF with EF<30%
Dilated CM
Endocarditis
Left atrial myxoma
Minor risk sources
Patent Foramen Ovale
Atrial Septal Aneurysms
Mitral Valve Prolapse
Calcific Aortic Valve or Bicuspid Aortic Valve
Mitral Annular Calcification
Fibroelastomas (benign tumors on valves)
Lambi excrescences (filliform outgrowths from free borders
of valves)
Treatment
Primary prophylaxis depends on the
particular risk factor but centers
primarily around anti-coagulation,
especially in the high-risk group (except
for endocarditis and myxoma)
Primary prophylaxis for medium or low
risk factors is less clear as benefit of
anti-coagulation is not yet proven
Treatment of acute embolic stroke
depends on the source of the stroke but
centers primarily around anti-
References
Caplan, Louis. “Etiology and
classification of Stroke.” Up to Date
Online. Web. 30 Sept 2009.
Schneck, Michael. “Cardioembolic
stroke.” emedicine. WebMD. Web. 13
Feb 2008.
Alguire, Patrick; Epstein, Paul. MKSAP
14. ACP. 2006.