The Common Coincidence of Carotid and Cardiac Lesions

Abstract

All of 184 consecutive patients with TIA (68) and cerebral infarction (116) admitted to an investigative stroke unit had cardiac monitoring with a Hewlett Packard 78524 arrhythmia monitoring system. In addition, 127 underwent 2-D echo cardiography and 113 had conventional or digital intravenous cerebral angiography. From the clinical history and examination and all the cardiac investigations, 59 patients (32 %) (21 with TIA’s and 38 with strokes) had a possible cardiac source of emboli. In 30 (16 %) (9 TIA and 21 stroke patients) the heart was the most likely source of cerebral emboli but after cerebral angiography 29 of the 59 patients (16 %) also showed a vascular lesion in the appropriate carotid artery so that no definite decision could be made regarding the source of emboli. Cardiac and carotid lesions with embolic potential often coexist in the same patient, making a full investigation mandatory before an etiology can be ascribed. Even then, an open mind and close follow up are required to assure appropriate management.