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Medizin - Open Access LMU - Teil 05/22 Podcast
Prognose der kardialen Hirnembolie

Prognose der kardialen Hirnembolie

Medizin - Open Access LMU - Teil 05/22 vor 40 Jahren

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In a retrospective study the reports of 211 cases of cardiogenic
cerebral embolism - diagnosed on the base of neurological and
cardiological findings - were analyzed in view of signs and
findings of prognostic value. There were 21 patients with TIA, 39
cases of RIND and 151 patients with cerebral infarction, 60 of
which showed mild and 91 severe neurological symptoms. 38 patients
died during the period of hospitalization. While sex of the
patients as well as vascular risk factors (hypertension, diabetes
mellitus, cigarette smoking) did not influence the clinical course
of the disease, patients with TIA or RIND in general were younger
(about 5 years) than those with severe stroke. Prognosis of
cardiogenic cerebral embolism depended to a great degree on the
underlying heart disease. Cerebral embolism after myocardial
infarction showed a better remission of symptoms than embolism in
atrial fibrillation. In the group of valvular diseases the course
of embolic strokes in mitral lesions was worse than in aortal valve
disease. Prognosis was worst in endocarditis, both in view of
neurological deficit and of mortality. Mostly, the cardiogenic
emboli lead to infarctions of the middle cerebral artery territory
(78 per cent) with a predilection for the left hemisphere. In
media-syndromes the clinical course was significantly worse in
patients with additional homonymous visual defect compared to
incomplete infarctions. Initial disturbance of conscience reduced
prognosis quoad vitam et restitutionem significantly. Of the
neuroradiological findings, the detection of arterial occlusion or
circulatory disturbance in angiography as well as the finding of an
ischemic lesion in computed axial tomography (CAT) was correlated
with a severe course of the embolic stroke. While 7 patients with
hemorrhagic infarction in CAT-Scan showed no differences in the
clinical course, the 14 patients with pathological cerebral spinal
fluid findings in embolism had an unfavourable prognosis. The
development of epileptic seizures did not influence the further
course of the infarction to a significant extent. Results are
compared with the current world literature.