SPECIFIC CARDIOLOGICAL EVALUATION AFTER FOCAL CEREBRAL-ISCHEMIA

Purpose of this study was to define a subgroup of TIA/stroke patients who should be examined by transthoracal and transesophageal echocardio graphy or Holter-electrocardiography to identify those with cardiogeni c brain embolism reliably; 300 consecutive patients with acute focal b rain ischemia underwent a standardized diagnostic protocol for the eva luation of the etiology including, clinical examination by a cardiolog ist and routine electrocardiography, Holter-electrocardiography, trans thoracal and transesophageal echocardiography. 188 patients had a pote ntial cardiac source of embolism. In particular echocardiography was d iagnostic in 163 patients, and Holter-electrocardiography 10; 159 of t hese 188 patients (84.6%) had competitive etiologies, predominantly la rge vessel atherosclerosis. In 136 patients cardiogenic brain embolism was assumed as quite definite or possible. To identify these patients reliably, transthoracal and transesophageal echocardiography would ha ve been necessary in 89% of the entire group of patients (all with cli nically cardiological abnormalities, pathological routine EGG, without vascular risk factors, or no atherosclerosis in duplex sonography), a nd Holter-electrocardiography in 54%.