Table 2. Acute Ischemic Stroke Features and Cardiac Investigationsa.
| Patient No. | Clinical symptoms of ischemic stroke | Stroke location | Stroke classificationb | Treatment | NIHSS score on admission | NIHSS score 24 h after admission | Pretreatment brain imaging | Large vessel occlusion location | Transthoracic echocardiography findings |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Right hemiplegia, dysarthria, and aphasia | Left insula and lentiform | Undetermined | Recombinant tPA and EVT | 23 | 26 | CTB and CTA | Left proximal MCA | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 2 | Right-sided ataxia, hemiplegia, and dysarthria | Left internal capsule | Small vessel occlusion | Recombinant tPA | 5 | 1 | MRI brain and MRA | None | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 3 | Dysarthria, vertigo, and unsteady gait | Bilateral cerebellar | Undetermined | Medical therapy | 2 | 1 | MRI brain and MRA | None | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 4 | Left hemiplegia | Right internal capsule | Small vessel occlusion | Medical therapy | 9 | 9 | MRI brain and MRA | None | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 5 | Left-sided numbness, hemiplegia, left hemianopia, and dysarthria | Right PCA territory | Undetermined | Medical therapy | 10 | 12 | MRI brain and MRA | Right PCA | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 6 | Right hemiplegia, dysarthria, global aphasia, and right-sided neglect | Left MCA territory | Undetermined | EVT | 25 | 20 | CTB and CTA | Left TICA | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 7 | Right hemiplegia and aphasia | Left MCA territory | Cardioembolism | Recombinant tPA and EVT | 19 | Intubated and sedated | CTB and CTA | Left TICA and distal left MCA | Left ventricular thrombus seen, EF 50%, and akinetic segment at the apex |
| 8 | Left hemiplegia, dysarthria, and left-sided neglect | Right MCA territory | Undetermined | EVT | 12 | 8 | CTB and CTA | Right proximal MCA | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 9 | Right hemiplegia and aphasia | Left MCA territory | Undetermined | Recombinant tPA and EVT | 19 | Intubated and sedated | CTB and CTA | Left TICA | Normal chamber sizes, EF 55%-60%, and no RWMA. No intracardiac shunt or mass |
| 10 | Left facial droop and left hemiplegia | Bilateral MCA territory | Undetermined | Medical therapy | 2 | 0 | CTB and CTA | Bilateral ICA but with intact intracranial | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 11 | Dizziness and unsteady gait | Left inferior cerebellum | Undetermined | Medical therapy | 1 | 0 | CTB and CTA | None | Normal chamber sizes, EF 55%-60%, and no RWMA. No intracardiac shunt or mass |
| 12 | Right hemiplegia and dysarthria | Left MCA territory | Undetermined | Medical therapy | 6 | 6 | CTB, MRI brain, and MRA | Left proximal MCA | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 13 | Left-sided ataxia and hemiplegia | Right MCA territory | Undetermined | Medical therapy | 2 | 2 | CTB, MRI brain, and MRA | None | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
| 14 | Right-sided weakness and ataxia | Left PCA territory | Undetermined | Medical therapy | 5 | 5 | CTB and CTA | Left PCA | Normal chamber sizes, EF 55%-60%, and no RWM; no intracardiac shunt or mass |
| 15 | Left-sided weakness and numbness | Right PCA territory | Cardioembolism | Medical therapy | 1 | 1 | MRI brain and MRA | Right PCA | Normal chamber sizes, EF 60%, and no RWMA; no intracardiac mass; patent foramen ovale seen and confirmed on TEE; TCD shows Spencer grade V right-to-left shunt |
| 16 | Dysarthria | Left frontal and right parietal | Cardioembolism | Medical therapy | 1 | 0 | CTB, MRI brain, and MRA | None | Normal chamber sizes, EF 65%, and no RWMA; no intracardiac shunt or mass; color turbulent flow seen across the interatrial septum because of presence of patent foramen ovale |
| 17 | Right monoparesis and dysphagia | Left caudate and lentiform nucleus | Undetermined | Medical therapy | 5 | 1 | CTB, MRI brain, and MRA | None | Normal chamber sizes, EF 65%, and no RWMA; no intracardiac shunt or mass |
| 18 | Ataxia | Left hemipontine | Undetermined | Medical therapy | 1 | 0 | CTB, MRI brain, and MRA | None | Normal chamber sizes, EF 55%-60%, and no RWMA; no intracardiac shunt or mass |
Abbreviations: CTA, computed tomography angiography; CTB, computed tomography of the brain; EF, ejection fraction; EVT, endovascular therapy; ICA, internal cerebral artery; MCA, middle cerebral artery; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; NIHSS, National Institutes of Health Stroke Scale; PCA, posterior cerebral artery; RWMA, regional wall motion abnormalities; TCD, transcranial doppler; TEE, transesophageal echocardiography; TICA, terminal internal cerebral artery; tPA, tissue plasminogen activator.
a
All patients had normal sinus rhythm based on 48 to 72 hours of telemetry.
b
Stroke classification was based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.