CEREBRAL ISCHEMIC EVENTS - WHEN AND HOW T O LOOK FOR CARDIOEMBOLIC SOURCES

In industrialized countries, cerebral ischemic events rank third among the most frequent causes of death. In survivors, long-term disability may result. The diagnosis and therapy of preventable causes is theref ore a major task. Echocardiography has proven to be most helpful in th e search for cardioembolic sources, and the transesophageal approach ( TEE) is superior to the transthoracic (TTE) in this specific indicatio n. In patients in whom a cardioembolic source can be identified by cli nical examination, 12-lead surface ECG or chest X-ray, an additional e chocardiographic examination is not necessary Patients under 50 with c erebral ischemic events should undergo TEE. In patients over 70 with a contraindication for long-term anticoagulant therapy, TEE has no ther apeutic consequences and should therefore not be performed. In patient s aged between 50 and 70 the diagnostic procedure of choice must be co nsidered in each individual patient. It should be kept in mind that a more aggressive approach using TEE, from which therapeutic conclusions are drawn, has not clearly been shown to improve the prognosis of pat ients with cerebral ischemic events.