Abstract

Objectives

Several cardiovascular, structural, and functional abnormalities have been considered as potential causes of cardioembolic ischemic strokes. Beyond atrial fibrillation, other sources of embolism clearly exist and may warrant urgent action, but they are only a minor part of the many stroke mechanisms and strokes that seem to be of embolic origin remain without a determined source. The associations between stroke and findings like atrial fibrillation, valve calcification, or heart failure are confounded by co-existing risk factors for atherosclerosis and vascular disease. In addition, a patent foramen ovale which is a common abnormality in the general population is mostly an innocent bystander in patients with ischemic stroke. For these reasons, experts from the national Danish societies of cardiology, neurology, stroke, and neuroradiology sought to develop a consensus document to provide national recommendations on how to manage patients with a suspected cardioembolic stroke. Design: Comprehensive literature search and analyses were done by a panel of experts and presented at a consensus meeting. Evidence supporting each subject was vetted by open discussion and statements were adjusted thereafter. Results: The most common sources of embolic stroke were identified, and the statement provides advise on how neurologist can identify cases that need referral, and what is expected by the cardiologist. Conclusions: A primary neurological and neuroradiological assessment is mandatory and neurovascular specialists should manage the initiation of secondary prophylactic treatment. If a cardioembolic stroke is suspected, a dedicated cardiologist experienced in the management of cardioembolism should provide a tailored clinical and echocardiographic assessment.

中文翻译：

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对疑似心源性缺血性卒中患者的评估。全国共识声明

摘要

目标

几种心血管、结构和功能异常已被认为是心源性缺血性卒中的潜在原因。除了心房颤动之外，显然存在其他栓塞来源并且可能需要采取紧急行动，但它们只是许多中风机制中的一小部分，而且似乎是栓塞来源的中风仍然没有确定的来源。中风与心房颤动、瓣膜钙化或心力衰竭等发现之间的关联被共存的动脉粥样硬化和血管疾病风险因素混淆。此外，普通人群中常见的卵圆孔未闭，多是缺血性脑卒中患者的无辜旁观者。出于这些原因，来自丹麦国家心脏病学、神经病学、中风学会的专家，设计：综合文献检索和分析由专家小组完成，并在共识会议上提出。通过公开讨论审查支持每个主题的证据，然后调整声明。结果：确定了最常见的栓塞性卒中来源，该声明就神经科医生如何识别需要转诊的病例以及心脏病专家的预期提供了建议。结论：初级神经学和神经放射学评估是强制性的，神经血管专家应管理二级预防性治疗的开始。如果怀疑有心源性卒中，在心源性栓塞管理方面经验丰富的专门心脏病专家应提供量身定制的临床和超声心动图评估。