Cardiogenic Stroke: Prevention, Diagnosis and Treatment

Dear Colleagues,

The term cardiogenic stroke defines a very varied set of situations and possible causes for ischemic cerebrovascular disease. From a diagnostic and therapeutic point of view, this is difficult to consider as a single entity. In fact, the therapeutic choices for an embolic stroke in the context of bacterial endocarditis, given the same brain lesion pattern, is very different to that of the same cerebral lesional picture caused by atrial fibrillation or endocavitary thrombosis. Furthermore, the currently growing area of paradoxical embolism highlights the need for careful patient selection prior to starting a dedicated and multidisciplinary diagnostic path. Different again is the context of cardioembolic stroke in the most classic and frequent situation, i.e. atrial fibrillation, in the patient with multiple pathologies and with coexisting cerebral microangiopathy, in particular cerebral amyloid angiopathy, especially if already expressed with an intracranial hemorrhagic event. The starting point for investigations into neurovascular ambiguity is often also the presence of a stroke with an embolic lesion pattern but without clear evidence of an embolic source. The investigation, particularly in the context of the search for paroxysmal atrial fibrillation, is often long and not always fruitful. A fundamental contribution on the neurovascular side is from neuroradiology and management of the patient's team. Close collaboration between the vascular neurologist and the neuroradiologist often allows the diagnostic path to be better defined.

For the above reasons, a plurality of situations and points of view in a multidisciplinary patient management path with dedicated management weeks is the most practical approach in the clinical context.

However, all of these aspects are different and contribute to the variety of an etiopathogenetic category of stroke that has in the past been considered much more homogeneous than it actually is. 

Dr. Marialuisa Zedde and Dr. Rosario Pascarella

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