POTENTIAL CARDIOEMBOLIC SOURCES OF STROKE IN PATIENTS LESS-THAN-60 YEARS OF AGE

Minor potential cardioembolic sources of stroke such as atrial septal aneurysm or patent foramen ovale are important risk factors for crypto genic stroke. We aimed to determine the prevalence of these abnormalit ies through an exhaustive aetiological work-up. One hundred and eighte en stroke patients under 60 years of age, who had no evidence of a sig nificant cardiac source of embolism, were classified into four groups following transoesophageal echocardiography and assessment of cervical arteries. Group A comprised 30 patients (25.4%) who had an arteriopat hy, probably related to stroke without ally cardiac abnormality; group B, had only a potential cardiac source; group C, nine (7.6%) had an o bvious arterial source of stroke and incidental cardiac abnormalities; group D, 30 (25.4%) had neither cardiac or arterial source. Data were analysed with the Chi-square test to compare risk factors between gro ups, and variance analysis was used to compare age between groups. Sig nificance was assessed as P<0.05. Fisher's exact test was used to test the association between arterial septal aneurysm and patent foramen o vale. In groups B and D atrial septal aneurysm represented 56.8% of th e cardiac abnormalities and was diagnosed 35.4% of the 79 patients who had an unexplained stroke, and a patent foramen ovale was found in 34 .1% of the patients. According to Fisher's exact test, atrial septal a neurysm was significantly associated with patent foramen ovale (P much less than 0.001). On this basis, one fourth of the patients might be said to have had a truly cryptogenic stroke as the aetiological work-u p failed to demonstrate any source of stroke. Comparison between group s showed that in 23% of the patients in whom an arterial source was de tected, there was also a potential cardioembolic source (group C), vs 62% in patients who had no arterial source (groups B and D) (P=0.0007) . Our study confirmed the strong association between atrial septal ane urysm, patent foramen ovale and stroke. Although there was a lower inc idence of cardiac risk factors for stroke in patients who had cervical artery disease, we suggest that all patients who have a stroke withou t evidence of a major cardiac source should undergo transoesophageal e chocardiography, in order to ensure a better prevention.