Cerebrovascular attacks with embolization etiology from a cardiac source - the role of echocardiography and tactics of anticoagulant treatment
Abstract
Cerebrovascular attacks with an embolic etiology from a cardiac source account for 20-25 % of ischaemic cerebrovascular attacks. After haemorrhage into the CNS is ruled out, during CT examination of these patients the feasibility of anticoagulant treatment is considered.
Unless there are contraindications far this treatment, in patients with atrial fibrillations during hospitalization warfarin therapy is initiated. In patients with a sinus rhythm transthoracic, and if possible, also transoesophageal echocardiography is used to detect the source of possible embolization.
If a thrombus is detected in the left atrium, an echocontrast in the left atrium, a thrombus in the left ventricle and open foramen ovale or defect of the atrial septum, thrombi in the aorta, anticoagulant treatment is started. If the echocardiographic examination reveals a mitral valve prolapse, aneurysm of the atrial septum or atheroma in the aorta, only antiaggregation treatment with acetylsalicylic acid or ticlopidine is indicated.