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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1981 Sep;44(9):803–809. doi: 10.1136/jnnp.44.9.803

The role of two-dimensional echocardiography in the detection of potentially embolic intracardiac masses in patients with cerebral ischaemia.

R M Donaldson, R W Emanuel, C J Earl
PMCID: PMC491140  PMID: 7310421

Abstract

The M-mode and two dimensional echocardiographic data of 62 consecutive cardiac patients referred from neurology centres were analysed retrospectively to establish the use of these techniques in detecting underlying cardiac pathology. All patients had presented initially to a neurologist with transient or permanent focal cerebral or retinal ischaemia, and had been referred for cardiac assessment after neurological investigations failed to establish the underlying cause of the neurological event. Patients were divided into two groups. In 30 patients the referring neurologist had found no evidence of cardiac disease (Group I); in the other 32 patients either heart disease or an arrhythmia had been diagnosed prior to cardiac referral (Group II). One of the patients in Group I had echocardiographic evidence of mitral valve prolapse not detected by the neurologist prior to referral; no cardiac pathology was recognised in the other 29 patients in this group. In seven of the 32 (22%) patients from Group II, a cardiac mass presumed responsible for the neurological manifestations was demonstrated echocardiographically, and in six of these histological confirmation was obtained following surgery or at necropsy. Two dimensional echocardiography was the only investigation which visualised the intracardiac pathology in four patients. In the remaining three patients, valve vegetations (two cases) and an atrial tumour (one case) were demonstrated by both echocardiographic methods. In patients with either clinical evidence of cardiac disease or an arrhythmia who have experienced one or more episodes of cerebral or retinal ischaemia, the presence of an intracardiac mass is not uncommon. Two dimensional echocardiography was the method of choice for detecting cardiac thrombus but the use of both methods of ultrasound should be considered as complementary techniques in the investigation of these cases. Routine echocardiography is unlikely to be of value in screening patients who have had a cerebrovascular event and who do not have clinical evidence of heart disease or an arrhythmia.

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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., Sharma B., Hodges M. Observations on detecting left ventricular thrombus with two dimensional echocardiography: emphasis on avoidance of false positive diagnoses. Am J Cardiol. 1981 Jan;47(1):145–156. doi: 10.1016/0002-9149(81)90303-9. [DOI] [PubMed] [Google Scholar]
  2. Barnett H. J., Boughner D. R., Taylor D. W., Cooper P. E., Kostuk W. J., Nichol P. M. Further evidence relating mitral-valve prolapse to cerebral ischemic events. N Engl J Med. 1980 Jan 17;302(3):139–144. doi: 10.1056/NEJM198001173020303. [DOI] [PubMed] [Google Scholar]
  3. Chusid M. J., Dale D. C., West B. C., Wolff S. M. The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine (Baltimore) 1975 Jan;54(1):1–27. [PubMed] [Google Scholar]
  4. DeJoseph R. L., Shiroff R. A., Levenson L. W., Martin C. E., Zelis R. F. Echocardiographic diagnosis of intraventricular clot. Chest. 1977 Mar;71(3):417–419. doi: 10.1378/chest.71.3.417. [DOI] [PubMed] [Google Scholar]
  5. DeMaria A. N., Bommer W., Neumann A., Grehl T., Weinart L., DeNardo S., Amsterdam E. A., Mason D. T. Left ventricular thrombi identified by cross-sectional echocardiography. Ann Intern Med. 1979 Jan;90(1):14–18. doi: 10.7326/0003-4819-90-1-14. [DOI] [PubMed] [Google Scholar]
  6. DeMaria A. N., Vismara L. A., Miller R. R., Neumann A., Mason D. T. Unusual echographic manifestations of right and left heart myxomas. Am J Med. 1975 Nov;59(5):713–720. doi: 10.1016/0002-9343(75)90232-6. [DOI] [PubMed] [Google Scholar]
  7. Finegan R. E., Harrison D. C. Diagnosis of left atrial myxoma by echocardiography. N Engl J Med. 1970 Apr 30;282(18):1022–1023. doi: 10.1056/NEJM197004302821808. [DOI] [PubMed] [Google Scholar]
  8. Grindal A. B., Cohen R. J., Saul R. F., Taylor J. R. Cerebral infarction in young adults. Stroke. 1978 Jan-Feb;9(1):39–42. doi: 10.1161/01.str.9.1.39. [DOI] [PubMed] [Google Scholar]
  9. Hall S. W., Jr, Theologides A., From A. H., Gobel F. L., Fortuny I. E., Lawrence C. J., Edwards J. E. Hypereosinophilic syndrome with biventricular involvement. Circulation. 1977 Jan;55(1):217–222. doi: 10.1161/01.cir.55.1.217. [DOI] [PubMed] [Google Scholar]
  10. Horgan J. H., Shiel F. O., Goodman A. C. Demonstration of left ventricular thrombus by conventional echocardiography. J Clin Ultrasound. 1976 Aug;4(4):287–288. doi: 10.1002/jcu.1870040411. [DOI] [PubMed] [Google Scholar]
  11. Kisslo J., vonRamm O. T., Thurstone F. L. Cardiac imaging using a phased array ultrasound system. II. Clinical technique and application. Circulation. 1976 Feb;53(2):262–267. doi: 10.1161/01.cir.53.2.262. [DOI] [PubMed] [Google Scholar]
  12. Kramer N. E., Rathod R., Chawla K. K., Patel R., Towne W. D. Echocardiographic diagnosis of left ventricular mural thrombi occurring in cardiomyopathy. Am Heart J. 1978 Sep;96(3):381–383. doi: 10.1016/0002-8703(78)90050-9. [DOI] [PubMed] [Google Scholar]
  13. Lappe D. L., Bulkley B. H., Weiss J. L. Two-dimensional echocardiographic diagnosis of left atrial myxoma. Chest. 1978 Jul;74(1):55–58. doi: 10.1378/chest.74.1.55. [DOI] [PubMed] [Google Scholar]
  14. Parrillo J. E., Borer J. S., Henry W. L., Wolff S. M., Fauci A. S. The cardiovascular manifestations of the hypereosinophilic syndrome. Prospective study of 26 patients, with review of the literature. Am J Med. 1979 Oct;67(4):572–582. doi: 10.1016/0002-9343(79)90227-4. [DOI] [PubMed] [Google Scholar]
  15. Popp R. L. Echocardiographic assessment of cardiac disease. Circulation. 1976 Oct;54(4):538–552. doi: 10.1161/01.cir.54.4.538. [DOI] [PubMed] [Google Scholar]
  16. Ports T. A., Cogan J., Schiller N. B., Rapaport E. Echocardiography of left ventricular masses. Circulation. 1978 Sep;58(3 Pt 1):528–536. doi: 10.1161/01.cir.58.3.528. [DOI] [PubMed] [Google Scholar]
  17. Reeder G. S., Lengyel M., Tajik A. J., Seward J. B., Smith H. C., Danielson G. K. Mural thrombus in left ventricular aneurysm: incidence, role of angiography, and relation between anticoagulation and embolization. Mayo Clin Proc. 1981 Feb;56(2):77–81. [PubMed] [Google Scholar]
  18. Schweizer P., Bardos P., Erbel R., Meyer J., Merx W., Messmer B. J., Effert S. Detection of left atrial thrombi by echocardiography. Br Heart J. 1981 Feb;45(2):148–156. doi: 10.1136/hrt.45.2.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Tajik A. J., Seward J. B., Hagler D. J., Mair D. D., Lie J. T. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. Mayo Clin Proc. 1978 May;53(5):271–303. [PubMed] [Google Scholar]
  20. Wilson L. A., Warlow C. P., Russell R. W. Cardiovascular disease in patients with retinal arterial occlusion. Lancet. 1979 Feb 10;1(8111):292–294. doi: 10.1016/s0140-6736(79)90704-9. [DOI] [PubMed] [Google Scholar]
  21. van den Bos A. A., Vletter W. B., Hagemeijer F. Progressive development of a left ventricular thrombus. Chest. 1978 Sep;74(3):307–309. doi: 10.1378/chest.74.3.307. [DOI] [PubMed] [Google Scholar]

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