Cerebral Embolization: Prospective Clinical Analysis of 42 Cases

Abstract

The sites, sources, and incidence of cerebral embolization were established in an unselected series of hospitalized patients using recommended epidemiological criteria. Criteria for diagnosis of cerebral embolization as a cause of stroke are defined. Forty-two (15%) from a total of 280 patients with various forms of cerebrovascular disease were diagnosed as having cerebral embolization. The epidemiology has been altered by antibiotics and cardiac surgery, particularly the use of prosthetic heart valves. In this series, the mortality rate was 9.5%, which is lower than in previously reported series probably due to emergency medical treatment. The heart was the most common source. Prosthetic heart valves emerged as the most common source of emboli in this series. Ulcerated plaques of the carotid arteries in the neck ranked second. Seizures occurred in 42.8% of cases. The left cerebral hemisphere was involved approximately twice as frequently as the right one. Possible explanations based on the anatomy of the great vessels are described which predispose to embolization of the left carotid artery. Recommendations are suggested for preventing further embolization and for treatment of acute embolic cerebral infarction by the use of anticonvulsant drugs and hyperosmolar agents designed to reduce cerebral edema.