USEFULNESS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN UNEXPLAINED CEREBRAL-ISCHEMIA

Two-hundred seventy consecutive patients with ''unexplained cerebral i schemia'' were studied with transesophageal echocardiography to determ ine the value of this test in identifying potential cardiac sources of cerebral embolism. The findings of this group were compared with thos e of 772 consecutive patients undergoing transesophageal echocardiogra phic evaluation for indications other than cerebral ischemia. This stu dy also examined this group of patients with unexplained cerebral isch emia to determine differences in relation to underlying cardiac rhythm and patient age. Intracardiac thrombus, atrial septal aneurysm, paten t foramen ovale, spontaneous left atrial contrast and protruding debri s in the thoracic aorta were found more often in patients with unexpla ined cerebral ischemia. Wall motion abnormalities of the left ventricl e, as well as mild to moderate valvular lesions including mitral valve prolapse, were found to be similar in both groups. Spontaneous left a trial contrast, as well as mild to moderate valvular abnormalities, we re found more often in patients with atrial fibrillation (22% of the g roup with unexplained cerebral ischemia). However, the presence of int racardiac thrombus was no more frequent in patients with atrial fibril lation than in those with normal sinus rhythm. Patients aged >50 years were found to have atrial fibrillation and larger left atrial size mo re often than their younger cohorts, as well as a greater incidence of valvular abnormalities and left ventricular wall motion abnormalities . Mitral valve prolapse was seen more frequently in the younger cohort of patients.