Cardiogenic brain embolism diagnosis [Neurosurgery Wiki]

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====== Cardiogenic brain embolism diagnosis ======

===== General information =====

No specific neurologic features can distinguish these patients. The diagnosis is suggested in imaging studies showing multiple intracranial ischemic strokes in different arterial distributions, the
differential diagnosis includes [[vasculitis]], intracranial atherosclerosis (focal plaques, more common in Asian populations that consume Western diets), and intravascular lymphomatosis.

The diagnosis of cardiogenic brain embolism (CBE) as a cause of a [[stroke]] relies on demonstrating a potential cardiac source, the absence of [[cerebrovascular disease]], and non-lacunar stroke.
Large areas of hemorrhagic transformation within an ischemic infarct may be more indicative of CBE due to thrombolysis of the clot and reperfusion of the infarcted brain with a subsequent hemorrhagic conversion. [[Hemorrhagic transformation]] most often occurs within 48 hrs of a CBE stroke and is more common with larger strokes.

===== Detection of cardiac source =====

Most centers rely on [[echocardiography]] (without transesophageal ability). Using restricted criteria
(i.e., excluding mitral valve prolapse), about 10% of patients with [[ischemic stroke]] will have potential
cardiac source detected by echo, and most of these patients have other manifestations of cardiac disease.
In [[stroke]] patients without clinical heart disease, only 1.5% will have a positive echo; the yield is
higher in younger patients without cerebrovascular disease
((Cerebral Embolism Task Force. Cardiogenic Brain
Embolism. Arch Neurol. 1989; 46:727–743)).

EKG may detect atrial fibrillation, which may be seen in 6–24% of ischemic strokes and may be
associated with a 5-fold increased risk of stroke.