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Cardioembolic stroke

Frans Kauw, Jan W Dankbaar, Jesse Habets, Maarten J M Cramer, Hugo W A M de Jong, Birgitta K Velthuis, L Jaap Kappelle
This case report describes a patient who experienced a recurrent ischemic stroke within 24 h. Dual-energy computed tomography (DECT) angiography on admission showed 2 intracardiac thrombi, 1 in the left ventricle and 1 in the left atrial appendage. Following the second ischemic event, repeated DECT angiography showed that the ventricular thrombus had considerably diminished, suggesting that the recurrent brain infarction was caused by cardioembolism. This case emphasizes (1) the potential benefit of cardiac evaluation through CT angiography in the acute stroke setting, and (2) the use of DECT angiography for the detection of thrombus and the differentiation between thrombus, the myocardial wall, and a slow flow of contrast...
May 2018: Case Reports in Neurology
Zhang-Ning Zhao, Xiao-Lin Li, Jin-Zhi Liu, Zhi-Ming Jiang, Ai-Hua Wang
BACKGROUND: Young ischemic stroke patients are common while classification and analysis based upon imaging characteristics are rarely reported. We intend to compare the clinical and MRI characteristics of cerebral stroke induced by intracranial atherosclerosis between young patients with branch occlusive disease (BOD) and those with non-branch occlusive disease (non-BOD) or small artery disease (SAD). METHODS: A total of 151 subjects with acute infarction within the middle cerebral artery (MCA) territory were included and patients with ipsilateral internal carotid artery stenosis or cardioembolism were excluded...
June 20, 2018: BMC Neurology
S Åsberg, B Farahmand, P Hasvold, S Johansson, P Appelros
OBJECTIVES: Our purpose was to explore major vascular and bleeding outcomes in relation to risk and severity scores (ABCD2 or NIHSS) in patients with transient ischemic attack (TIA) or acute ischemic stroke (AIS). METHODS: This nationwide observational study was based on data from 4 national registries. Outcomes were assessed by Kaplan-Meier and Cox regression analyses. RESULTS: The total cohort comprised 21 268 patients (median age 73 years, 47...
June 19, 2018: Acta Neurologica Scandinavica
Jean-Philippe Collet, Sergio Berti, Angel Cequier, Eric Van Belle, Thierry Lefevre, Pascal Leprince, Franz-Josef Neumann, Eric Vicaut, Gilles Montalescot
BACKGROUND: Antithrombotic treatment regimen following transcatheter aortic valve replacement (TAVR) is not evidence-based. Apixaban, a non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA and superior to aspirin to prevent cardioembolic stroke in non-valvular atrial fibrillation. It may have the potential to reduce TAVR-related thrombotic complications including subclinical valve thrombosis along with a better safety than the standard of care. DESIGN: ATLANTIS is a multicenter, randomized, phase IIIb, prospective, open-label, superiority study comparing standard of care (SOC Group) versus an apixaban-based strategy (Anti-Xa Group) after successful TAVR (ClinicalTrials...
June 2018: American Heart Journal
Ella Starobinska, Eric A Robinson, Eric Brucks, Serena Scott
Non-bacterial thrombotic endocarditis (NBTE) is a well-described phenomenon associated with malignancies due to hypercoaguable state. In the setting of pancreatic cancer, NBTE is more commonly diagnosed postmortem. We describe a case of a man who was diagnosed with pancreatic carcinoma after incidental finding of NBTE. Imaging incidentally revealed multiple strokes, bilateral renal and splenic infarcts, while subsequent workup for cardioembolic source demonstrated a 1.1×0.7 cm mitral valve vegetation. As multiple blood cultures were sterile and patient lacked clinical signs of infection, an underlying malignancy was suspected...
June 12, 2018: BMJ Case Reports
Maurizio Acampa, Pietro Enea Lazzerini, Francesca Guideri, Rossana Tassi, Andrea Lo Monaco, Giuseppe Martini
BACKGROUND: About one third of ischaemic strokes are classified as embolic strokes of undetermined source (ESUS). A silent atrial fibrillation (AF) may play a pathogenic role in these strokes and P wave dispersion (PWD), representing an electrocardiographic (ECG) predictor for paroxysmal AF, thereby a potential marker of covert cardioembolism, was found to be increased in cryptogenic stroke. Furthermore, current evidence links AF to inflammation: inflammatory markers, such as high-sensitive C-reactive protein (hsCRP), have been related to the development and persistence of AF, possibly by promoting atrial remodelling...
May 8, 2018: Heart, Lung & Circulation
Mehmet Akif Topcuoglu, Liping Liu, Dong-Eog Kim, M Edip Gurol
Cardiac embolism continues to be a leading etiology of ischemic strokes worldwide. Although pathologies that result in cardioembolism have not changed over the past decade, there have been significant advances in the treatment and stroke prevention methods for these conditions. Atrial fibrillation remains the prototypical cause of cardioembolic strokes. The availability of new long-term monitoring devices for atrial fibrillation detection such as insertable cardiac monitors has allowed accurate detection of this leading cause of cardioembolism...
May 2018: Journal of Stroke
Junxia Bai, Houchao Sun, Liang Xie, Yongjun Zhu, Yuxing Feng
BACKGROUND: B-type natriuretic peptides (BNPs) have shown promise in detecting cardioembolic stroke. However, there has been little investigation comparing the diagnostic efficacy of BNP and its cleavage by-product N-terminal peptide (NT-proBNP) in cardioembolic stroke patients. Therefore, the aim of this meta-analysis will be to comparatively assess the diagnostic efficacy of BNP versus NT-proBNP in distinguishing cardioembolic stroke from non-cardioembolic stroke in adult ischemic stroke patients...
June 6, 2018: International Journal of Neuroscience
Kallirroi I Kalantzi, Ioannis V Ntalas, Vasileios G Chantzichristos, Maria E Tsoumani, Dimitrios Adamopoulos, Christos Asimakopoulos, Adamantios Bourdakis, Petros Darmanis, Alexandra Dimitriadou, Stefanos Gkiokas, Konstantinos Ipeirotis, Kyriaki Kitikidou, Ioannis Klonaris, Aglaia Kostaki, Dimitrios Logothetis, Konstantinos Mainas, Theodoros Mais, Athanasios Maragiannis, Konstantina Martiadou, Konstantinos Mavronasos, Ioannis Michelongonas, Dimitrios Mitropoulos, Georgios Papadimitriou, Achilleas Papadopoulos, Miltiadis Papaioakeim, Kosmas Sofillas, Sotiria Stabola, Emmanouil Stefanakis, Dimitrios Stergiou, Maria Thoma, Alexandros Zenetos, Stergios Zisekas, John A Goudevenos, Demosthenes B Panagiotakos, Alexandros D Tselepis
BACKGROUND: Triflusal has demonstrated an efficacy similar to aspirin in the prevention of vascular events in patients with acute myocardial infarction (ΜΙ) and ischaemic stroke but with less bleeding events. OBJECTIVE: We performed a randomised, multicentre, phase 4 clinical trial to compare the clinical efficacy and safety of triflusal versus aspirin, administered for 12 months in patients eligible to receive a cyclooxygenase-1 (COX-1) inhibitor. METHOD: Patients with stable coronary artery disease or with a history of non-cardioembolic ischaemic stroke were randomly assigned to receive either triflusal 300 mg twice or 600 mg once daily or aspirin 100 mg once daily for 12 months...
June 4, 2018: Current Vascular Pharmacology
N V Tsygan, R V Andreev, A S Peleshok, S V Kolomentsev, V A Yakovleva, A V Ryabtsev, M A Gumennaya, I V Litvinenko
AIM: To study risk factors, characteristics of clinical symptoms and diagnosis, and possibilities of prevention of perioperative stroke and other clinical types of cerebral dysfunction in main types of heart valve surgery. MATERIAL AND METHODS: The study included 83 patients, aged 63 (54; 70) years, undergoing heart valve surgery with cardiopulmonary bypass. RESULTS: Postoperative cerebral dysfunction was diagnosed in 37.3% of cases, including perioperative stroke in 3...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Zhengde Tang, Lefeng Zeng, Yanjun Lin, Zhihua Han, Jun Gu, Changqian Wang, Huili Zhang
BACKGROUND: Left atrial appendage (LAA) is gaining increasing attention in patients with atrial fibrillation (AF) in the context of cardioembolic stroke. Galectin-3 (Gal-3) is a mediator of profibrotic pathways and is associated with an increased incidence of heart failure. However, the role of Gal-3 in LAA remodelling and thrombus formation in AF has not been evaluated. METHODS: This prospective study included 153 consecutive patients with paroxysmal (n=58), persistent (n=55) or permanent (n=40) nonvalvular AF...
May 14, 2018: Heart, Lung & Circulation
Rufus O Akinyemi, Mayowa O Owolabi, Masafumi Ihara, Albertino Damasceno, Adesola Ogunniyi, Catherine Dotchin, Stella-Maria Paddick, Julius Ogeng'o, Richard Walker, Raj N Kalaria
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa...
May 25, 2018: Brain Research Bulletin
Wenbo Zhao, Shuyi Shang, Chuanhui Li, Longfei Wu, Chuanjie Wu, Jian Chen, Haiqing Song, Hongqi Zhang, Yunzhou Zhang, Jiangang Duan, Wuwei Feng, Xunming Ji
BACKGROUND AND PURPOSE: Long-term follow-up of large trials have confirmed the superiority of endovascular thrombectomy (ET) for treating acute ischemic stroke (AIS). However, it is still unknown whether these results can be generalized to clinical practice. In this study, we aimed to determine the long-term outcomes of AIS post-ET in the real-world clinical practice. METHODS: This observational study is based on a single-center prospective registry study. AIS patients were treated with second-generation stent retrievers from December 2012 to April 2016...
July 15, 2018: Journal of the Neurological Sciences
Chan-Hyuk Lee, Hyun Goo Kang, Ji Sung Lee, Han Uk Ryu, Seul-Ki Jeong
PURPOSE: Right-to-left shunt (RLS) through a patent foramen ovale (PFO) is likely associated with ischemic stroke. Many studies have attempted to demonstrate the association between RLS and ischemic stroke. However, information on the association between the degree of RLS and the subtypes of ischemic stroke categorized by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification is lacking. METHOD: This was a retrospective study involving 508 patients with ischemic stroke who underwent a transcranial Doppler (TCD) microbubble test between 2013 and 2015...
July 15, 2018: Journal of the Neurological Sciences
S V Kotov, E V Isakova, Yu A Belova, A V Zmislinskiy, I G Kolchu, M V Kucheryavaya, Ya A Pustinnikov, L V Smetana, V V Sashin, N P Chernih
AIM: To compare the efficacy and safety of systemic thrombolytic therapy (STLT) in patients with cardioembolic stroke (CE) versus other pathogenic subtypes of ischemic stroke (IS). MATERIAL AND METHODS: The study included 147 patients, 62 women and 85 men (mean age - 62.9±0.8 years) including 37 patients (25.2%) with CE subtype of IS (group 1) and 110 patients with other pathogenetic subtypes of IS (group 2). NIHSS and Rankin scale were used to assess patient's neurological status...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
L B Novikova, G M Minibaeva
Ischemic stroke (IS) is one of the leading causes of death and disability worldwide. Among all the causes of IS, cardioembolic stroke (CEI) accounts for up to 40%. Based on the literature data, modern ideas about the role and location of cardiac diseases in the pathogenesis of CEI are presented. The leading cause of CEE is non-rheumatic atrial fibrillation. Numerous attempts to study and prove the genetic nature of the development of IS led to the discovery of new markers - micribonucleic acids (microRNAs), the regulators of gene expression, that inhibit mRNA translation and play a key role in the pathogenesis of IS...
2018: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
Seunguk Jung, Cheolkyu Jung, Jae Hyoung Kim, Byung Se Choi, Yun Jung Bae, Leonard Sunwoo, Ho Geol Woo, Jun Young Chang, Beom Joon Kim, Moon-Ku Han, Hee-Joon Bae
Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed...
January 1, 2018: Interventional Neuroradiology
Hayang Yang, Martina Nassif, Paul Khairy, Joris R de Groot, Yvo B W E M Roos, Robbert J de Winter, Barbara J M Mulder, Berto J Bouma
Cardioembolic sources account for 20-30% of ischaemic strokes and are important to identify considering their prognostic and therapeutic implications. During the past years, new developments have been made in the cardiac diagnostic evaluation and management of patients with ischaemic stroke, especially regarding strokes of unknown aetiology. These recent advances have had a major impact on our understanding of embolic strokes, their diagnostic work-up, and clinical management. Herein, we propose a cardiac diagnostic work-up scheme for patients with ischaemic stroke from definite cardioembolic sources and embolic strokes of undetermined source...
May 21, 2018: European Heart Journal
Ken Yasuda, Shunichi Fukuda, Michikazu Nakamura, Ryo Ohtani, Yasuhiro Kuwata, Masaki Takata, Makoto Sainouchi, Masahiro Gotou, Yuichi Masuda, Satoru Kawarazaki, Yasuhiro Kawabata, Nagako Murase, Tomokazu Aoki, Naohiro Yonemoto, Masaharu Akao, Tetsuya Tsukahara
BACKGROUND: Large-scale clinical trials have analyzed risk factors for any ischemic stroke in patients with atrial fibrillation (AF). However, the risk factors for cardioembolic stroke (CES), specifically, have not been reported. To clarify the risk factors for CES and clinically significant cardioembolic infarction, we examined the incidence of CES and larger infarct volume (IV) (> 30 mL) CES, employing the Fushimi AF Registry, a community-based prospective cohort of AF patients in the Fushimi ward, Kyoto, Japan...
May 22, 2018: Cerebrovascular Diseases Extra
Carlos R Camara-Lemarroy, Nicolás Escobedo-Zúñiga, Francisco J Guzmán-de la Garza, Jorge Castro-Garza, Javier Vargas-Villarreal, Fernando Góngora-Rivera
Experimental studies suggest that the intestinal barrier is affected in ischemic stroke. D-Lactate and intestinal fatty acid-binding protein (IFABP) are markers of intestinal mucosa integrity and barrier function. Our purpose was to evaluate the serum concentrations of these markers in patients with acute ischemic stroke (AIS). We included patients with AIS and used healthy subjects as controls. Clinical, demographic and outcome measures were recorded. Blood was drawn within 24 h of symptom onset. Serum concentrations of D-Lactate and IFABP were determined using commercially available colorimetric and ELISA kits, respectively...
May 21, 2018: Acta Neurologica Belgica
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