Symptoms Of Embolic Stroke

Sudden Onset and Maximal Severity

One of the hallmark symptoms of an embolic stroke is the sudden onset of symptoms, which are typically at their most severe right from the beginning . This rapid development is a key indicator that differentiates embolic strokes from other types of strokes.

Cortical and Subcortical Lesions

Embolic strokes often result in lesions localized to the cortical or subcortical regions of the brain. These lesions are typically found in areas supplied by the major branches of the anterior cerebral artery (ACA), middle cerebral artery (MCA), or posterior cerebral artery (PCA). The absence of proximal vascular stenosis or occlusion further supports the diagnosis of an embolic stroke.

Multiple Vascular Territories

Clinical or radiographic evidence of embolic infarcts in multiple vascular territories, including both the central nervous system and systemic circulation, is another significant symptom. These infarcts can also be found at the grey-white matter junction.

Large Lesions in Specific Territories

In the lenticulostriate or thalamogeniculate territories, lesions greater than 1 cm should raise suspicion of an embolic origin. This is a distinguishing feature that helps in identifying the embolic nature of the stroke.

Cerebellar Hemispheric Infarction

Embolic strokes can also present as cerebellar hemispheric infarctions, which are less common but still significant indicators.

Loss of Consciousness and Rapid Onset

Loss of consciousness at the onset of symptoms is another critical indicator of a cardiac source of embolism. This symptom, while highly specific, is not very sensitive and may not be present in all cases .

Aphasia Without Hemiparesis

Certain clinical features such as Wernicke’s aphasia or global aphasia without hemiparesis are suggestive of a cardioembolic stroke. These symptoms are particularly indicative when they occur suddenly and without other common stroke symptoms like hemiparesis.

Co-occurrence of Cerebral and Systemic Emboli

The simultaneous occurrence of cerebral and systemic emboli is a strong indicator of an embolic stroke. This co-occurrence often points to a cardiac source of the emboli.

Risk Factors and Sources of Embolism

Identifying a possible embolic source is crucial for diagnosis. Common sources include thrombi in the heart, aortic arch, or great vessels, as well as conditions like atrial fibrillation, valvular disease, and cardiomyopathy. Even in the absence of a high-risk source, an embolic mechanism should not be excluded, as up to 40% of ischemic strokes are cryptogenic.

Differences in Stroke Severity

Patients with embolic strokes of undetermined source (ESUS) often present with mild symptoms compared to those with cardioembolic strokes, which tend to be more severe. However, the distribution of lesions in ESUS is more similar to cardiogenic embolism, suggesting a complex pathogenesis .

Conclusion

Embolic strokes are characterized by a sudden onset of severe symptoms, specific lesion localizations, and the potential involvement of multiple vascular territories. Identifying the source of embolism and understanding the clinical features are crucial for accurate diagnosis and effective treatment. The presence of specific symptoms such as loss of consciousness, aphasia without hemiparesis, and the co-occurrence of cerebral and systemic emboli further aid in distinguishing embolic strokes from other types.

Symptoms of embolic stroke

Summary

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