Why the study?
How often can a cardiac source for embolism be correctly suspected on clinical grounds in patients with cerebral infarction?
How often can a cardiac source for embolism be correctly suspected on clinical grounds in patients with cerebral infarction?
Clinical diagnostic criteria alone miss a significant proportion of cardiac embolic sources in stroke patients, particularly mural thromboembolism from ischemic heart disease, accounting for discrepancies between clinical and autopsy studies.
Clinical suspicion misses many cardiac emboli in stroke; supports imaging validation studies before changing practice.
A retrospective case note survey of 103 autopsy proven cases of cerebral infarction was carried out to assess how often a cardiac source for embolism had been correctly suspected on clinical grounds. Only 61% of 46 patients with cardiac embolic sources were so identified. Cases of rheumatic heart disease and bacterial endocarditis were more frequently identified than cases of mural thromboembolism from ischaemic heart disease. This relative failure of unaided clinical diagnostic criteria probably accounts for the discrepancy between the autopsy evidence of cardiac embolism as a cause of stroke (about 40%), and clinical studies (about 20%).
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Humphrey et al. (1985) studied this question.
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