Potential Sources of Emboli in Transient Cerebral and Retinal Ischaemia

Abstract

91 consecutive patients with transient ischaemic attacks (TIAs) were examined for potential source of emboli using echo cardiography and ambulatory ECG monitoring in addition to clinical examination and angiography. Patients were divided into those with amaurosis fugax and/or carotid TIAs (45),“hemiphenomena” TIAs (26) and vertebrobasilar TIAs (20).“Structural” cardiac defects (of which mitral valve prolapse accounted for just under half) occurred in 34% of patients, significantly more than in age-matched controls. 40% of patients with amaurosis fugax and/or carotid TIAs had carotid artery lesions, as did 30% of those with “hemiphenomena” attacks. 6 patients had both cardiac and carotid lesions. Arrhythmias were detected in 15% of patients and a similar proportion of controls. Hypertension and ischaemic heart disease were more common in the patients.Structural cardiac abnormalities, which may not be haemodynamically significant, might account for cerebral and retinal emboli in about a third of patients presenting with TIAs. The natural history and the most effective therapy of this subgroup require evaluation independently of patients with predominantly carotid atheromatous lesions.