Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis.
Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis.
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DOI：
10.2174/157340310791658730
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发表时间：
2010-08
影响因子：
1.9
通讯作者：
Alió J
中科院分区：
文献类型：
--
作者：
Arboix A;Alió J
这篇文章为读者提供了一个概述和最新的临床特征，特殊的心脏疾病和预后的心栓性中风。心栓性中风占缺血性中风的14-30%，通常是一种严重的情况；心栓性脑梗塞患者容易早期和长期中风复发，尽管复发可以通过急性期的适当治疗和后续的严格控制来预防。某些临床特征提示为心栓性脑梗塞，包括突然发作到最大限度的缺失、发病时意识水平下降、韦尼克失语或全面性失语而不伴有偏瘫、中风发作时的瓦尔萨尔瓦动作，以及脑血栓和全身血栓的并存。腔隙的临床表现，腔隙梗死，特别是多发性腔隙梗死，使心脏栓塞源不太可能发生。更常见的高危心脏栓塞症是房颤、近期心肌梗死、机械瓣膜置换、扩张性心肌病和二尖瓣狭窄。经胸和经食道超声心动图可发现器质性心脏病。动态心电图监测可发现阵发性房性心律失常。与其他类型的脑梗塞相比，心源性卒中的住院死亡率最高(在本组中为27.3%)。根据我们的经验，早期血栓复发患者(前7天内)的住院死亡率为77%。酗酒、高血压、心脏瓣膜病、恶心呕吐和既往脑梗塞患者早期复发系统性栓塞的风险增加。对于没有跌倒、依从性差、癫痫失控或胃肠道出血等禁忌症的心源性卒中复发高危患者，如有可能，应立即开始使用抗凝剂进行二级预防。
This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of cardioembolic stroke. Cardioembolic stroke accounts for 14-30% of ischemic strokes and, in general, is a severe condition; patients with cardioembolic infarction are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The more common high risk cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.