This registry study highlights that cerebral embolism accounts for nearly a quarter of strokes, frequently originating from identifiable cardiac sources.
Infarction secondary to cerebral embolism was diagnosed in 127 (23.5%) of 540 patients in the Michael Reese Stroke Registry. Coronary artery disease, atrial fibrillation, valvular heart disease, mitral annulus calcification, and cardiomyopathy were the commonest etiologies. Echocardiography documented a potential embolic source in 7 patients without previously known heart disease, and clarified the cardiac pathology in many of the patients with known heart disease. The left anterior circulation was affected in 48%, right anterior in 37%, and posterior circulation in 15% of patients. CT was abnormal in 71% of the patients, and was approximately equally helpful in all locations. Nineteen percent of emboli presented with a deficit that was other than maximal at onset. Concurrent systemic embolism was unusual (2.3%). Prognosis was somewhat worse than in thrombotic stroke. Grouping of patients according to embolic source (intra-arterial, cardiac, and uncertain source) showed no differences in activity at onset, early course, or in subsequent course of the illness.
Caplan et al. (1983) studied this question.