Neurologic manifestations of cardiogenic embolism - An update

Stroke should be considered a syndrome and not a single disease, and this is especially true when stroke is the result of cardiogenic embolism. Increasing evidence about new potential sources of embolism and the recognition of different risk groups with established causes of cardioembolic strokes in recent years continue to challenge clinicians in diagnosis and management. The frequent coexistence of noncardioembolic etiologies of stroke (approximately 20%) in patients with potential cardioembolic sources makes management decisions even more difficult.(26) On the other hand, cardioembolic strokes are largely preventable, making early recognition paramount. The big challenge is first to establish a firm cause-effect relationship and then to stratify the risk of individual patients to choose the best therapy. When weighing treatment alternatives, it is the absolute risk reduction in stroke by a therapy, determined in part by the absolute rate of stroke with each specific cardioembolic source, that is crucial. Basic concepts about cardiogenic embolism to the brain have been comprehensively reviewed elsewhere.(10, 11,16) This article focuses on new data and concepts from the past 5 years.