Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 Jul;56(7):760–764. doi: 10.1136/jnnp.56.7.760

Mechanism of late stroke after myocardial infarct: the Lausanne Stroke Registry.

R Martín 1, J Bogousslavsky 1
PMCID: PMC1015056  PMID: 8331350

Abstract

To assess the potential mechanisms and patterns of late stroke after myocardial infarct, 94 consecutive patients with first ever stroke at least three months after myocardial infarction (anterior 67%; inferior 12%; widespread 12%) were studied. Systematic investigations were those of the Lausanne Stroke Registry and included brain CT, extra/transcranial Doppler ultrasound, 12-lead ECG, three-lead continuous ECG monitoring for at least 24 hours after admission, and transthoracic two dimensional echocardiography. All patients had an akinetic left ventricular segment, but only 11 (12%) had a visible thrombus. Eleven (12%) of the patients had long standing hypertension and a small deep infarct so that lacunar infarction due to small artery disease was as likely to be the cause as cardioembolic stroke. There was severe internal carotid artery disease (> or = 50% stenosis or occlusion) ipsilateral to the infarct in 20 (21%) of the patients with anterior circulation stroke. A potential cardiac source of embolism other than akinetic left ventricular segment was found in 14 (15%) patients, atrial fibrillation (12%) being the commonest. Only 13 (14%) patients had no potential cause for stroke other than akinetic left ventricular segment. The study group was compared with 466 patients with first stroke but no akinetic left ventricular segment on two dimensional echocardiography, and with 94 patients with first stroke and a potential cardiac source of embolism but no akinetic left ventricular segment and no history of ischaemic heart disease. Logistic regression analysis showed that older age, male sex, hypercholesterolaemia, and vascular claudication were significantly and independently associated with stroke after myocardial infarction. The findings suggest that late stroke after myocardial infarction may often be a direct consequence of the sequelae of myocardial infarction, but other potential cardiac causes of stroke, large artery disease, and lacunar stroke must also be considered.

Full text

PDF
762

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asinger R. W., Mikell F. L., Elsperger J., Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med. 1981 Aug 6;305(6):297–302. doi: 10.1056/NEJM198108063050601. [DOI] [PubMed] [Google Scholar]
  2. Bergeron G. A., Shah P. M. Echocardiography in patients with acute cerebral events. Clin Cardiol. 1982 Dec;5(12):637–639. doi: 10.1002/clc.4960051203. [DOI] [PubMed] [Google Scholar]
  3. Blackwood W., Hallpike J. F., Kocen R. S., Mair W. G. Atheromatous disease of the carotid arterial system and embolism from the heart in cerebral infarction: a morbid anatomical study. Brain. 1969;92(4):897–910. doi: 10.1093/brain/92.4.897. [DOI] [PubMed] [Google Scholar]
  4. Bogousslavsky J., Cachin C., Regli F., Despland P. A., Van Melle G., Kappenberger L. Cardiac sources of embolism and cerebral infarction--clinical consequences and vascular concomitants: the Lausanne Stroke Registry. Neurology. 1991 Jun;41(6):855–859. doi: 10.1212/wnl.41.6.855. [DOI] [PubMed] [Google Scholar]
  5. Bogousslavsky J., Hachinski V. C., Boughner D. R., Fox A. J., Viñuela F., Barnett H. J. Cardiac and arterial lesions in carotid transient ischemic attacks. Arch Neurol. 1986 Mar;43(3):223–228. doi: 10.1001/archneur.1986.00520030015005. [DOI] [PubMed] [Google Scholar]
  6. Bogousslavsky J., Van Melle G., Regli F., Kappenberger L. Pathogenesis of anterior circulation stroke in patients with nonvalvular atrial fibrillation: the Lausanne Stroke Registry. Neurology. 1990 Jul;40(7):1046–1050. doi: 10.1212/wnl.40.7.1046. [DOI] [PubMed] [Google Scholar]
  7. Bogousslavsky J., Van Melle G., Regli F. The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988 Sep;19(9):1083–1092. doi: 10.1161/01.str.19.9.1083. [DOI] [PubMed] [Google Scholar]
  8. Caplan L. R., Hier D. B., D'Cruz I. Cerebral embolism in the Michael Reese Stroke Registry. Stroke. 1983 Jul-Aug;14(4):530–536. doi: 10.1161/01.str.14.4.530. [DOI] [PubMed] [Google Scholar]
  9. Chambers B. R., Donnan G. A., Bladin P. F. Patterns of stroke. An analysis of the first 700 consecutive admissions to the Austin Hospital Stroke Unit. Aust N Z J Med. 1983 Feb;13(1):57–64. doi: 10.1111/j.1445-5994.1983.tb04552.x. [DOI] [PubMed] [Google Scholar]
  10. Damasio H. A computed tomographic guide to the identification of cerebral vascular territories. Arch Neurol. 1983 Mar;40(3):138–142. doi: 10.1001/archneur.1983.04050030032005. [DOI] [PubMed] [Google Scholar]
  11. Dexter D. D., Jr, Whisnant J. P., Connolly D. C., O'Fallon W. M. The association of stroke and coronary heart disease: a population study. Mayo Clin Proc. 1987 Dec;62(12):1077–1083. doi: 10.1016/s0025-6196(12)62499-9. [DOI] [PubMed] [Google Scholar]
  12. FISHER C. M. LACUNES: SMALL, DEEP CEREBRAL INFARCTS. Neurology. 1965 Aug;15:774–784. doi: 10.1212/wnl.15.8.774. [DOI] [PubMed] [Google Scholar]
  13. Fuster V., Gersh B. J., Giuliani E. R., Tajik A. J., Brandenburg R. O., Frye R. L. The natural history of idiopathic dilated cardiomyopathy. Am J Cardiol. 1981 Mar;47(3):525–531. doi: 10.1016/0002-9149(81)90534-8. [DOI] [PubMed] [Google Scholar]
  14. Fuster V., Halperin J. L. Left ventricular thrombi and cerebral embolism. N Engl J Med. 1989 Feb 9;320(6):392–394. doi: 10.1056/NEJM198902093200610. [DOI] [PubMed] [Google Scholar]
  15. Gagliardi R., Benvenuti L., Frosini F., Ammannati F., Barletta G. A., Fantini F. Frequency of echocardiographic abnormalities in patients with ischemia of the carotid territory--a preliminary report. Stroke. 1985 Jan-Feb;16(1):118–120. doi: 10.1161/01.str.16.1.118. [DOI] [PubMed] [Google Scholar]
  16. Ghika J., Bogousslavsky J., Regli F. Infarcts in the territory of the deep perforators from the carotid system. Neurology. 1989 Apr;39(4):507–512. doi: 10.1212/wnl.39.4.507. [DOI] [PubMed] [Google Scholar]
  17. Good D. C., Frank S., Verhulst S., Sharma B. Cardiac abnormalities in stroke patients with negative arteriograms. Stroke. 1986 Jan-Feb;17(1):6–11. doi: 10.1161/01.str.17.1.6. [DOI] [PubMed] [Google Scholar]
  18. Gottdiener J. S., Gay J. A., VanVoorhees L., DiBianco R., Fletcher R. D. Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography. Am J Cardiol. 1983 Dec 1;52(10):1281–1285. doi: 10.1016/0002-9149(83)90588-x. [DOI] [PubMed] [Google Scholar]
  19. Greenland P., Knopman D. S., Mikell F. L., Asinger R. W., Anderson D. C., Good D. C. Echocardiography in diagnostic assessment of stroke. Ann Intern Med. 1981 Jul;95(1):51–53. doi: 10.7326/0003-4819-95-1-51. [DOI] [PubMed] [Google Scholar]
  20. Hochberg Y., Benjamini Y. More powerful procedures for multiple significance testing. Stat Med. 1990 Jul;9(7):811–818. doi: 10.1002/sim.4780090710. [DOI] [PubMed] [Google Scholar]
  21. Keren A., Goldberg S., Gottlieb S., Klein J., Schuger C., Medina A., Tzivoni D., Stern S. Natural history of left ventricular thrombi: their appearance and resolution in the posthospitalization period of acute myocardial infarction. J Am Coll Cardiol. 1990 Mar 15;15(4):790–800. doi: 10.1016/0735-1097(90)90275-t. [DOI] [PubMed] [Google Scholar]
  22. Kittner S. J., Sharkness C. M., Price T. R., Plotnick G. D., Dambrosia J. M., Wolf P. A., Mohr J. P., Hier D. B., Kase C. S., Tuhrim S. Infarcts with a cardiac source of embolism in the NINCDS Stroke Data Bank: historical features. Neurology. 1990 Feb;40(2):281–284. doi: 10.1212/wnl.40.2.281. [DOI] [PubMed] [Google Scholar]
  23. Kittner S. J., Sharkness C. M., Sloan M. A., Price T. R., Dambrosia J. M., Tuhrim S., Wolf P. A., Mohr J. P., Hier D. B., Caplan L. R. Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: neurologic examination. Neurology. 1992 Feb;42(2):299–302. doi: 10.1212/wnl.42.2.299. [DOI] [PubMed] [Google Scholar]
  24. Komrad M. S., Coffey C. E., Coffey K. S., McKinnis R., Massey E. W., Califf R. M. Myocardial infarction and stroke. Neurology. 1984 Nov;34(11):1403–1409. doi: 10.1212/wnl.34.11.1403. [DOI] [PubMed] [Google Scholar]
  25. McAllen P. M., Marshall J. Cerebrovascular incidents after myocardial infarction. J Neurol Neurosurg Psychiatry. 1977 Oct;40(10):951–955. doi: 10.1136/jnnp.40.10.951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Ramirez-Lassepas M., Cipolle R. J., Bjork R. J., Kowitz J., Snyder B. D., Weber J. C., Stein S. D. Can embolic stroke be diagnosed on the basis of neurologic clinical criteria? Arch Neurol. 1987 Jan;44(1):87–89. doi: 10.1001/archneur.1987.00520130067019. [DOI] [PubMed] [Google Scholar]
  27. Rem J. A., Hachinski V. C., Boughner D. R., Barnett H. J. Value of cardiac monitoring and echocardiography in TIA and stroke patients. Stroke. 1985 Nov-Dec;16(6):950–956. doi: 10.1161/01.str.16.6.950. [DOI] [PubMed] [Google Scholar]
  28. Rosa A., Masmoudi K., Barbieux D., Cartz L., Mizon J. P., Lesbre J. P. Echocardiographie bidimensionnelle dans 100 cas d'accidents ischémiques cérébraux inexpliqués. Presse Med. 1990 Jan 20;19(2):73–75. [PubMed] [Google Scholar]
  29. Stratton J. R., Nemanich J. W., Johannessen K. A., Resnick A. D. Fate of left ventricular thrombi in patients with remote myocardial infarction or idiopathic cardiomyopathy. Circulation. 1988 Dec;78(6):1388–1393. doi: 10.1161/01.cir.78.6.1388. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES