Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force.
Cardiogenic embolism has accounted for one in six ischemic strokes in recent clinical studies. We review the recent clinical literature about the natural history, diagnosis, and management of cardioembolic stroke. Long-term anticoagulation may be indicated for primary stroke prevention in high-risk patient subgroups with non-rheumatic atrial fibrillation. The prevalence of left ventricular thrombi, and probably also emboli, following an acute anterior myocardial infarction has been reduced by heparin, but the value of subsequent oral anticoagulation for persistent left ventricular thrombi has been disputed. Two clinical subgroups of mitral valve prolapse have been emerging: one benign and the other prone to complications, including embolism. Paradoxical embolism has increasingly been reported as contrast echocardiography has permitted a reliable diagnosis of patent foramen ovale. The embolic risk of infective endocarditis is low (less than 5%) when infection is controlled; early embolism during uncontrolled infection does not strongly predict later stroke. Low-intensity anticoagulation (international normalized ratio, 2.0 to 3.0) may be sufficient prophylaxis for many embolism-prone cardiac disorders.